Outbreak countries

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.

A child in Malawi getting the Oral Polio Vaccine drops. ©Moving Minds Multimedia/Malawi

A total of nine wild poliovirus cases have been reported so far, with one in Malawi and eight in neighbouring Mozambique since the declaration of an outbreak on 17 February 2022 in Malawi. The last confirmed case to date was in August 2022 in Mozambique. The wild poliovirus in Malawi and Mozambique originated from Pakistan, one of the two last endemic countries.

Concerted emergency response launched following the outbreak in 2022 has helped increase protection among children through vaccines in Malawi, Mozambique, Zambia, Tanzania and Zimbabwe. The countries have also ramped up disease surveillance and community mobilization to help find cases and halt the virus.

“Southern Africa countries have made huge efforts to bolster polio detection, curb the spread of the virus and ensure that children live without the risk of infection and lifelong paralysis,” said Dr Matshidiso Moeti, World Health Organization (WHO) Regional Director for Africa. “We continue to support the polio control efforts across the region so that every child receives the protection they need.”

To date, 19 vaccination rounds have been concluded in the most at-risk areas and at least five more are planned for 2023 in the five countries.

Additionally, more than 10 new environmental surveillance sites have been set up over the past year in the affected countries with support from WHO. The fully operational sites are playing a critical role in the efforts to detect silent circulating poliovirus in wastewater.

“Response teams have worked intensely in the fight against polio not only in Malawi but in the rest of the neighbouring countries in a coordinated manner. We will not rest until we reach and vaccinate every child to stop polio transmission,” said Dr Emeka Agbo, acting Country Coordinator for the Global Polio Eradication Initiative in Malawi.

Reaching all households where eligible children live is critical to protect them against the risk of paralysis. The national health authorities, with support from the Global Polio Eradication Initiative, efforts are ongoing to map cross-border communities, migratory routes, border crossings and transit routes.

“Community health workers have been pivotal in the vaccination campaigns and will continue going door-to-door, bringing polio vaccines to children who might otherwise be missed,” said Dr Jamal Ahmed, WHO Polio Eradication Programme Manager.

Polio is highly infectious and affects unimmunized or under immunized children. In Malawi and Mozambique, it has paralysed children younger than 15 years. There is no cure for polio, and it can only be prevented by immunization. Children across the world remain at risk of wild polio type 1 as long as the virus is not eradicated in the last remaining areas in which it is still circulating.

Despite the circulation of wild poliovirus type 1 and the variant polioviruses, incredible progress has been made. Since 1988, when the Global Polio Eradication Initiative was set up, polio cases have plummeted by 99% from an estimated annual total of 350 000.

Importation of any case must be treated as a serious concern and high-quality response efforts to reach every child with polio vaccine are critical to prevent further spread.

On 25 January 2023, the WHO Emergency Committee under the International Health Regulations concluded that the risk of international spread of poliovirus remains a public health emergency of international concern.

Originally published here.

Women make up only 28% of the workforce in science, technology, engineering and math (STEM), and men vastly outnumber women majoring in most STEM fields in college globally. On March 2011, the Commission on the Status of Women adopted a report at its 55^th session to promote women’s equal access to full employment and decent work. Two years later, on 20 December 2013, the UN General Assembly adopted a resolution in which it was noted that it is imperative for women and girls to be involved in STEM.

On the International Day of the Women and Girls in Science on 11 February 2023, Rosemary Mukui Nzunza, the head of the Expanded Programme on Immunization (EPI) at the Centre for Virus Research, the Kenya Medical Research Institute, shared her story of pursuing a career in science. She is currently in the final stages of working towards earning her PHD in Molecular Medicine.

Rosemary explains she would like girls and women to know there is enough room for everyone in science; and women should maintain healthy competition in science and go as far as they can. It also helps to look for mentors and people you can admire and follow so they inspire you to keep growing, she says.

“Research has earned this name as it means you need to go back and search over and over again,” Rosemary says. “Besides, there are no ceilings in science – girls and women can go as far as they want to.”

As a child, Rosemary Nzunza spent her free time pounding leaves, roots and tubers, using thick wooden sticks to create “medicine”. Her creativity, curiosity, and love for finding explanations for how things work made her want to teach science − or at least work in the world of science.

Rosemary never has a dull day at work. She currently serves as Senior Research Scientist and Head of Division of the Expanded Programme on Immunization (EPI) at the Centre for Virus Research at KEMRI. Her role entails monitoring quality assurance in laboratory work and biosafety and overseeing the work of the different units at KEMRI. She also represents the laboratory in key national committees in Kenya: the National Committee on Containment of Polioviruses (NTF), National Polio Certification Committee (NPCC), National Measles and Rubella Technical Advisory Committee (MTAG) and the National Polio Experts Committee (NPEC).

Rosemary joined the Kenya Medical Research Institute (KEMRI) Laboratory 23 years ago, starting her career as a research officer with the US Army Medical Research Directorate (USAMRD). In 2006, Rosemary earned her Master’s in Applied Microbiology. Back then, she was one of just two women at the unit who had postgraduate degrees under their belts. She reflects on how her male colleagues looked up to the two women as mentors, which made them feel really proud. But she notes that this also meant they were in charge of all laboratory procedures, laboratory quality, and the troubleshooting, which was quite challenging at the time.

Polio still exists

When Rosemary joined KEMRI, she was surprised to learn that the institution was tasked with supporting polio eradication. She had thought polio had been wiped out from the world a long time ago.

Children wait to be vaccinated during house-to-house visits for a national polio vaccination campaign in Mogadishu, Somalia, on Tuesday 06 June 2022. Photo credits: ©WHO/ Ismail Taxta

Presently, Rosemary and her team at the KEMRI Laboratory work meticulously on testing samples of measles, polio and rubella. They know their work is integral to saving children from the harsh effects of preventable diseases, such as polio. Their work on polio is two-pronged: they have been testing samples for acute flaccid paralysis (AFP) since 2000 and environmental surveillance (ES) since 2013. AFP is defined by the acute onset of weakness or paralysis with reduced muscle tone in children. There are many infectious and non-infectious causes of AFP. Polio, caused by wild poliovirus (the naturally circulating strain) is one cause of AFP, and so early detection of AFP is critical in containing a potential outbreak. Respiratory and stool samples are optimal for enterovirus detection. Environmental surveillance complements AFP surveillance. It entails collecting and testing wastewater samples and can help in the early detection of and response to polioviruses. By identifying polioviruses swiftly, countries can stop their spread.

At times, the 17-member team receives an overwhelming number of samples at once from countries in the Region facing polio outbreaks. This presents a challenge, as it might mean the team needs more supplies for testing and needs to work longer hours to deliver timely results.

Once they have tested samples, they interpret results for each and send them back to the country to guide further and swift action. By 3 pm Eastern African Time every Friday, the KEMRI team works to send summaries of test results on measles, polio and rubella to the national surveillance office within Kenya’s Ministry of Health and other partners. These include the WHO Regional Office for Africa (AFRO); WHO Eastern Mediterranean Regional Office (EMRO); WHO headquarters; and the US Centers for Disease Control and Prevention (CDC).

Management during COVID-19 was a challenge

One of the most difficult times Rosemary has faced in her career was the response to the COVID-19 pandemic. During that period, she felt like health workers were carrying the weight of the entire world. In Kenya, her team was tasked with supporting the government in conducting COVID-19 tests. At the time, everything seemed so uncertain. Personal protective equipment (PPE) kits looked frightening, people all over the world were dying of COVID-19, and procedures and test kits still needed validation. She remembers thinking to herself, “Someone has to do this. And it’s us, here, now.”

Agnes Chepkurui, a lab technologist, preparing samples to determine what kind of poliovirus is present in the sample.
Photo credit: WHO/L. Dore

Similar to the situation health workers around the world faced, her team was also afraid of being infected with COVID-19, especially before vaccines were available. Rosemary recalls the team staying at work for long, tiring stretches, partially to avoid contact with their families, out of fear of inadvertently putting them at any risk of being infected with COVID-19. Teammates would huddle together and discuss their after-work protocol at home: slip in through the back door, disinfect clothes, clean up rigorously, take a shower, avoid all contact with loved ones, and set off on the same routine the next day before anyone woke up.

She split the team into two shifts to manage the immense workload. The aim was to prevent the team from burning out and ensuring their new work on COVID-19 didn’t slow down the other, crucial support to disease elimination that still needed to be carried out. Looking back now, Rosemary credits the support she and her team received from the management at KEMRI, colleagues, partners, friends and family with helping them stay focused and rise to the unprecedented challenges of that time.

She also attributes the success of the KEMRI EPI Division Laboratories to support from institutions across the world, including the Global Polio Eradication Initiative (GPEI) partners. She says she has always been impressed with the incredible support from WHO and the rest of the GPEI partnership, where diverse agencies come together to tackle one goal.

More mentors needed for girls to join and grow in science

The young lady who stepped foot out of her village in Machakos county – in Kenya – for the first time when she left for Eldoret to earn her Bachelor’s in Science Education has come a long way. She is keen to see other girls and women take their place at the forefront of science – but only if they have a passion for this field, she adds. Breaking into a laugh, she says there’s a lot to read and keep up with every single day. After all, science is about changing the world.

On 19 January 2023, representatives from the World Health Organization (WHO), United Nations Children’s Fund (UNICEF), and the Ministry of Health of Syria concluded a three day joint mission on polio transition planning.

The team conducted various meetings with national counterparts, United Nations agencies and other stakeholders to assess the current situation, and identify the needs and resources required to maintain polio-essential functions and strengthen routine immunization to maintain Syria’s polio-free status. As part of the mission, the team agreed on the way forward to design a roadmap to support and sustain the ongoing integration of polio assets to ensure long-term benefits for immunization and emergency response.

While Syria is a polio-free country, it is at very high risk of imported polio outbreaks. In the last decade, the country experienced two polio outbreaks, including an outbreak of wild poliovirus following an importation from Pakistan in 2013, that paralyzed 36 children. In addition, a 2017 outbreak of circulating vaccine-derived poliovirus type 2 (cVDPV2) left 74 children paralyzed. In both cases, the country managed to contain the poliovirus and stopped the outbreak in less than a year using intensive polio vaccination campaigns and surveillance.

WHO is working closely with the Government and other stakeholders to maintain highly sensitive surveillance for polio and capacities to detect and respond to polio outbreaks swiftly. Furthermore, WHO and UNICEF are supporting the country to leverage the capacity and rich legacy built from years of polio operations to strengthen the essential immunization programme and capacities to detect and respond to other disease outbreaks.

“The main goal of this mission is to ensure that the polio essential functions are well preserved,” said Dr Rana Hajjeh, Director of Programme Management at WHO’s Regional Office for the Eastern Mediterranean. “We at WHO emphasize the importance of strengthening essential programmes like the national routine immunization and also strengthening the emergency response to take advantage of all the polio assets and building health systems. Overall, Syria has integrated polio functions very well in their national immunization programme and we will do our best to continue supporting them as needed,” she added.

Polio essential functions are managed by the Ministry of Health, with the technical and logistical support of WHO. Given the importance of ensuring the sustainability of functions, with support from Gavi, the Vaccine Alliance, both partners have been able to cover critical programme needs pertaining to routine immunization, including polio.

“While protecting the success achieved in containing the poliovirus outbreaks in record time, we should combine our efforts at all levels to maintain the high levels of immunity of the Syrian people against this life-threatening disease,” said Dr Iman Shankiti, WHO Representative a.i. for Syria. “WHO is working closely with the Ministry of Health and all other partners to resume the robust immunization programme in Syria,” she added.

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The programme is focusing on reaching zero-dose children (children who are either un- or under-immunized), in identified ‘consequential geographies’.

But what exactly are consequential geographies, and why are they so vital to the global effort to eradicate polio?

In this explanatory video, long-time polio eradicator and Director for polio eradication at WHO’s Eastern Mediterranean Region, Dr Hamid Jafari, explains more.

Children show their inked fingers - a sign they have been vaccinated against polio. © WHO/Afghanistan — Children show their inked fingers – a sign they have been vaccinated against polio. © WHO/Afghanistan

2022 may well go down in history as the year of contrasts in the global effort to eradicate polio. At first glance, with polio detections in places such as New York and London and an increase in cases in Pakistan, it may seem that the effort is backsliding. And while any detection of any poliovirus is a setback—particularly in areas where the disease had been long gone, like southeast Africa—a deeper analysis reveals a more encouraging story: 2022 saw perhaps some of the most significant progress in the programme’s history, and has set up the global polio effort for a unique opportunity to achieve success in 2023.

Endemic wild poliovirus transmission in both Pakistan and Afghanistan is becoming increasingly geographically restricted, with fewer virus lineages remaining active. The bulk of variant type 2 polio (cVDPV2) cases are also becoming more restricted, with 90% of all global cases restricted to three ‘consequential geographies’ (eastern Democratic Republic of Congo, northern Yemen and northern Nigeria). And emergency outbreak response efforts to wild poliovirus type 1 in southeast Africa continue to gain momentum.

To evaluate this progress as 2022 draws to a close, independent technical expert and advisory groups are taking an in-depth look at the prevailing epidemiology, assessing impact of eradication efforts and putting forth key strategic approaches to enable an all-out effort against the virus in the first half of 2023.

The first of these groups met in early October, when the Technical Advisory Group (TAG) for Pakistan reviewed vaccination coverage and disease surveillance across the country. Despite the increase in new cases, the TAG found the outbreak to be extremely geographically confined, thanks to concerted emergency efforts led by the government and supported by partners. Today, polio transmission is restricted to the six districts of southern Khyber Pakhtunkhwa province—a fraction of the country’s 180 districts. Encouragingly, the virus has not re-established a foothold outside the core outbreak zone, meaning the traditional reservoirs of Karachi, Peshawar and Quetta are no longer endemic to the virus, a historical first.

More good news came out of the TAG’s analysis of the genetic biodiversity of virus transmission. In 2020, Pakistan had 11 separate chains of virus transmission. This was reduced to four in 2021, and today, just one family of the virus remains in the country. The approaches being implemented in Pakistan are working—despite some serious challenges.

Pakistan’s polio team supporting flood relief efforts © NEOC

In September, Pakistan experienced catastrophic flooding that impacted more than 33 million people and submerged one third of the country under water. In the face of this tragedy, and despite being affected themselves, polio staff supported the broader relief efforts while adapting polio operations to ensure that the eradication effort could continue unabated. Long-time polio eradicator and Director for Polio Eradication in WHO’s Eastern Mediterranean Region, Dr Hamid Jafari, said: “Rarely have I seen such commitment and dedication than I have seen in Pakistan – from national leaders, to health workers, right to the mother and father on the ground.

They are making a huge difference to people’s lives, which goes far beyond the effort to eradicate polio.”

In December, a high-level delegation led by GPEI Polio Oversight Board (POB) Chair Dr Chris Elias, WHO Regional Director Dr Ahmed Al-Mandhari and UNICEF Regional Director George Laryea-Adjei visited Pakistan during a nationwide vaccination campaign. After meeting with women health workers, provincial and national polio coordinators and even the Prime Minister, the group concluded that there is unprecedented support and commitment to ending polio in the country in 2023.

In Afghanistan too, an epidemiological deep dive reveals a promising picture: just over twelve months on from the political developments in the country in 2021, access to all children in the country continues to improve, albeit against a tragic backdrop of a severe and acute humanitarian crisis. More than 3.5 million children in Afghanistan who had been out-of-reach for almost five years can now be reached with polio vaccines, and thanks to strong vaccination and disease surveillance efforts, polio transmission has been restricted to just two chains in two provinces. And following the country’s devastating earthquake in June, polio teams sprang into immediate action to both support the broader emergency relief effort and adapt polio operations.

This progress in Pakistan and Afghanistan is identical to what epidemiologists observed during the ‘end game’ efforts in global polio reservoirs in the past, notably Nigeria, India and Egypt, giving rise to optimism that these remaining two endemic countries are on the right track.

Expert groups focus on outbreaks…

2022 saw a number of high-profile polio events, like the detections in New York City and London, but it is important to recognize the distinction between these and the outbreaks that have the capacity to endanger, or at least significantly delay, the global eradication goal.

Aidan O’Leary, Director of the Global Polio Eradication Initiative (GPEI) at the World Health Organization (WHO), contextualized the situation: “90 percent of global media attention has been on the polio emergence in New York, London and Israel. However, 90 percent of actual cases are in eastern Democratic Republic of Congo, northern Yemen and northern Nigeria.” It is in those areas, commonly referred to as consequential geographies, that programmatic efforts must maintain their focus. Notably, these areas also overlap with some of the highest proportions of ‘zero-dose’ children—those who are either un- or under-vaccinated.

WHO medical officer Dr Audu Idowu conducts an acute flaccid paralysis examination in Jere Local Government Area, Borno State. ©WHO/Nigeria

While the outbreaks in northern Yemen and eastern DR Congo continue to expand at an alarming rate in 2022, the situation in northern Nigeria is far more encouraging. Nigeria accounted for two-thirds of all global cases in 2021, seeding outbreaks in 19 countries. In the second half of 2022, however, there has been a dramatic decrease in new detections, with just nine cases reported during that time.

In November, the Nigerian Government, with GPEI partners in attendance, hosted the Global Roundtable Discussion on variant type 2 polio outbreaks, reviewing progress in outbreak response following the upsurge in cases in 2021. The Roundtable recognized efforts to reach zero-dose children in consequential geographies throughout the country, in particular with the novel oral polio vaccine type 2 (nOPV2), as well as Nigeria’s focus on strengthening routine immunization with bivalent OPV and inactivated polio vaccine (IPV). Whichever strategy is used, however, the group cautioned: “coverage is king!” Any vaccine is only as good as the proportion of children it reaches.

The group’s conclusions and recommendations will be further evaluated by Nigeria’s Expert Review Committee on Polio Eradication and Routine Immunization (ERC).

Meanwhile, in southeast Africa, a comprehensive Outbreak Response Assessment reviewed the regional response to wild poliovirus type 1 (WPV1), linked to virus originating from Pakistan, with cases confirmed in Malawi and Mozambique. Experts noted the high-level, comprehensive support for the outbreak response across the region, and that vaccination campaigns have been consistently improving with time.

At the same time, the group concluded that the outbreaks are not over. With simultaneous outbreaks of WPV1, cVDPV1 and cVDPV2 affecting in particular Mozambique, the group put forward key recommendations and strategies, building on the momentum and knowledge gained over the past six months. These conclusions were further endorsed by the Africa Regional Certification Commission for Eradication (ARCC), which met in South Africa.

Challenges remain ahead. Zero-dose children must be reached, particularly in consequential geographies. Remaining financial resources to achieve success must be mobilized. Campaigns must be strengthened in southeast Africa. But despite initial appearances, 2022 put the world on an extremely strong footing to interrupt all remaining chains of poliovirus transmission by end 2023—the goal of the GPEI Strategy 2022-2026.

There is a clear momentum as the year draws to a close. We must carry it into 2023 for a final, concerted push. Success is in our hands.

Pledging table

2022 pledges from various donors

Dr Hamid Jafari, EMRO Director for Polio Eradication. © WHO/EMRO

Members of the Regional Subcommittee for Polio Eradication and Outbreaks in the Eastern Mediterranean reviewed recent progress during the 69th session of the Regional Committee. It was the sixth meeting of the subcommittee since it was formed during the 67th Regional Committee.

During the meeting Member States and partners reiterated their commitment to freeing current and future generations of children from polio and called for sustained efforts to end polio once and for all, including the pockets of wild poliovirus that linger in Afghanistan and Pakistan.

Visit the EMRO website for the full story.

This two-year old outbreak of circulating vaccine-derived poliovirus (cVDPV) type 2 began after the virus was imported from neighbouring Chad.

Click on the photo gallery to see what it took to close the outbreak.

The Global Polio Eradication Initiative (GPEI) has been informed of a case of paralytic polio in an unvaccinated individual in Rockland County, New York, United States.

The US Centers for Disease Control and Prevention (CDC) are coordinating with New York State health authorities on their investigation. Initial sequencing confirmed by CDC indicates that the case is type 2 VDPV.

Following the detection, the Global Polio Laboratory Network (GPLN) has confirmed that the VDPV2 isolated from the case is genetically linked to two Sabin-like type 2 (SL2) isolates, collected from environmental samples in early June in both New York and greater Jerusalem, Israel, as well as to the recently-detected VDPV2 from environmental samples in London, UK. Further investigations – both genetic and epidemiological – are ongoing to determine possible spread of the virus and potential risk associated with these various isolates detected from different locations around the world.

It is vital that all countries, in particular those with a high volume of travel and contact with polio-affected countries and areas, strengthen surveillance in order to rapidly detect any new virus importation and to facilitate a rapid response. Countries, territories, and areas should also maintain uniformly high routine immunization coverage at the district level and at the lowest administrative level to protect children from polio and to minimize the consequences of any new virus being introduced.

Any form of poliovirus anywhere is a threat to children everywhere. It is critical that the GPEI Polio Eradication Strategy 2022-2026 is fully resourced and fully implemented everywhere, to ensure a world free of all forms of poliovirus can be achieved.

Dashboard showing real-time data on active case finding and routine immunization from integrated supportive supervisory visits to priority sites in Senegal. © WHO

While the WHO Africa Region (AFRO) has been facing its last hurdle in eradicating polio of all types since being certified indigenous wild polio free in 2020, a circulating variant of polio virus type two has been present in 26 countries with more than 1,000 cases between them, coupled with the recent importation of two wild polio type 1 cases. To help reverse this trend, the WHO/AFRO Geographic Information Systems (GIS) Center is equipping over 200 key country office focal points and Ministry of Health personnel across 47 countries with essential innovative technologies to better address outbreaks with necessary speed and quality.

Concluding a series of one-week capacity-building workshops over the past six months and targeting of the WHO regions of Central, East & Southern, and West Africa – – the AFRO GIS Center, with the support of the Bill & Melinda Gates Foundation (BMGF), WHO HQ Polio Unit and GIS Centre for Health, the United States Centers for Disease Control and Prevention (CDC), and Novel-t on-boarded digital GIS and Mobile Health (mHealth) technologies to support regional and national agendas particularly on planning and analysis for improvement of surveillance, campaigns and outbreak response for polio and all other routine immunization and outbreaks. While the initial investment was made by polio these tools are being leveraged for all health interventions.

A group of participants from the AFRO Geographic Information System (GIS) and Information Visualization Capacity Building Training session, in Dakar, Senegal. © WHO

“These are solutions to advance national and regional agendas even beyond polio” stated Kebba Touray, Technical Manager – AFRO GIS Centre, “the COVID-19 pandemic response was able to advance using the AFRO polio GIS Centre’s technical support with the development of real-time data collection, analysis and monitoring tools and generated several products including dashboards (providing easy availability and visualization of information), which facilitated rapid decision making for response activities across the region.”

The GIS Capacity Building training transferred knowledge to key country office focal points and Ministry of Health personnel across Africa on innovations to better enable countries to:

Design country-level specific static and dynamic maps – using platforms such as Microsoft Power BI, and ArcGIS – for the outbreak response and provide real time analysis through the dashboards.
Provide country specific information visualization (using Dashboards) to publish in the existing AFR-mHealth workspace at AFRO and in their respective public health systems.
Develop data collection, data validation and monitoring mechanisms that provides increased accuracy on immunization information and populations through the Open Data Kit (ODK) platform to enhance mobile data collection.
Use AFRO GIS and information visualization innovative solutions at country level to receive real-time information on active surveillance visits conducted at health facility level, environmental surveillance site performance, rapid population estimates data, vaccination team movement during polio campaigns, among others.

“I am particularly eager to take back the new capacity I have on ODK and PowerBI when monitoring our entire Expanded Programme on Immunization (‎EPI)‎ interventions” stated participant Dexter Merchant, Assistant Director for Monitoring and Evaluation at the Ministry of Health in Liberia, “using ODK as the process to collect data on where we have essential services and where we don’t is going to make things move a lot faster and more efficiently in identifying gap, I am confident these tools will now be integrated in Liberia”.

John Kipterer and Frank Salet moderating a PowerBI training session at the GIS capacity building workshop in the Dakar. © WHO

To ensure sustainability, country accountability and ownership, in-country GIS working groups which will constitute personnel from WHO and Ministries of Health will be established to continue efforts of knowledge transfer and capacity building principally amongst data managers, GIS analysts, and surveillance officers.

In closing, the WHO Representative in Senegal, Dr. Lucile Imboua and host of the last training series emphasized the “need to ensure harmonization of all the GIS tools and to be flexible to accommodate the use of other tools across different programs.”

The underlining consensus from all WHO, government and partner participants is that in order to end polio and strengthen health systems, the region heavily relies on the innovative technologies of GIS in executing health responses. The use of GIS innovations with precision in accuracy, transparency, accountability and ease of application and sustainability provides a huge opportunity to reach every last child across the 47 countries, eradicate polio from the region, and serve public health for all.

Dr Mutahar Ahmed, R, reviewing the location of AFP cases with Dr Khaled Al-Moayad, Director of Disease Control and Surveillance in Sanaa, Yemen © Omar Nasr / WHO Yemen

At his office in Sana’a, Yemen, Dr Mutahar Ahmed stands before a wall-sized map of his country and feels the weight of the world on his shoulders.

“The situation here in Yemen is very complex, and the problems we face are quite immense,” said Dr Ahmed.

As Yemen’s national surveillance coordinator, Dr Ahmed leads the country’s acute flaccid paralysis (AFP) surveillance efforts, the primary means of tracking poliovirus transmission. With an explosive outbreak of circulating vaccine-derived poliovirus type 2 having paralysed 115 children and counting, and with swathes of the country’s infrastructure – from roads to hospitals – decimated by conflict, you’d be forgiven for thinking that his and his team’s efforts to surveil for poliovirus were falling short or otherwise compromised. But you’d be wrong.

In Yemen, despite a long-running conflict and complex humanitarian disaster that has significantly impacted health care, AFP surveillance indicators tell a promising story of a functioning system where case detection, sample collection and laboratory analysis – the steps that enable us to detect poliovirus so we can respond to it – are, in fact, on track.

Surveillance data allows the polio programme to identify new AFP cases and to test those cases to determine whether polio infection is the cause. In this way, a robust and wide-reaching AFP surveillance system enables health workers to detect the presence and circulation of poliovirus.

Dr Mutahar Ahmed, national surveillance coordinator, at a health facility in Sanaa, Yemen. © Omar Nasr / WHO Yemen

“In addition to our work building the engagement and knowledge of pediatricians and clinicians, we are reaching the community and community-based health care providers including traditional healers. We also appeal to families for their support in reporting cases. The more aware they are of the symptoms of paralysis in a child, the quicker our surveillance coordinators can collect the stool sample for analysis,” said Dr Ahmed.

Early detection of symptoms such as AFP is a crucial step in the chain of polio surveillance. If a case of paralysis is not reported within the first 14 days of the onset of symptoms, the reliability of testing the sample in the lab reduces significantly. In Yemen, the AFP surveillance system in high-risk districts is supported by volunteers trained in community-based surveillance. In 2021, 82% of AFP cases were detected early, within the first seven days of the onset of paralysis, which is above the global target of 80%.

Once a case is detected and stool samples are collected, it’s vital to make sure the samples reach the laboratory in good condition.

“Two stool samples are required from each child showing symptoms of paralysis. Both samples need to be collected within the first 14 days, 24 hours apart. They need to be correctly labelled, and their temperature needs to be maintained at between 2 and 8 degrees. Otherwise, they are not adequate samples,” said Dr Ahmed.

In 2021, 921 AFP cases were detected. Of these cases, 87.84% had adequate specimens collected, which is above the global target of 80%.

Along with stool adequacy, another key performance indicator for surveillance is the non-polio AFP rate. This refers to the detection of diseases, other than polio, that can cause AFP. Yemen’s non-polio AFP rate is 5.96 per 100,000 children aged below 15 years in 2021, significantly higher than the global standard of three per 100,000 for polio outbreak countries like Yemen. This accomplishment points to the sensitivity of Yemen’s surveillance system due to the relentless efforts and commitment of the surveillance personnel working with Dr Ahmed.

Dr Mutahar Ahmed, L, inspecting samples with Dr Abdullah Yahya, assistant national coordinator for AFP surveillance © Omar Nasr / WHO Yemen

Due to electricity shortages, maintaining the cold chain (keeping vaccines cold) and reverse cold chain (keeping stool samples cold) poses a significant challenge for the programme. To overcome this and further increase the efficiency and sensitivity of the surveillance system to detect polioviruses as quickly as possible, solar power panels have been installed in health facilities at the central and governorate levels to support the storage and transfer of stool samples. One indicator of the impact of this change is Yemen’s non-polio enterovirus rate, which tells us what percent of stool samples tested negative for poliovirus, but were in such condition that they could still test positive for enteroviruses. In 2021, that rate was 20 percent above the global target of 10 percent.

Because Yemen does not have a poliovirus laboratory in-country for testing, samples are first collected at the central level in Sana’a and then sent by road to Muscat, Oman. The journey can take up to seven days, barring any obstacles or emergencies.

“Working in this role is a challenge, but what I particularly enjoy is how we are able to turn these challenges into opportunities for the AFP surveillance programme. The AFP indicators for the last year show us how far we have come in our journey,” said Dr Ahmed.

He explained why these indicators are so critical to the polio programme.

“The fact that our indicators are above the minimum global standards shows that the surveillance system is functioning, sensitive and responsive, despite the critical humanitarian situation. The data from our surveillance work has helped us identify the outbreak of circulating vaccine-derived polioviruses type-1 and type-2. The situation is quite fragile, but we are committed to addressing these challenges, and we will continue to do so.”

WHO has supported Yemen to establish an environmental surveillance system to supplement its AFP surveillance system and support early detection of polioviruses and more timely responses.

Following wide engagement of stakeholders – from lab workers to engineers to certification bodies responsible for signing off on the lockdown of poliovirus strains after certification of eradication – WHO’s chief guidance document for poliovirus containment has been given an overhaul. The update to the WHO Global Action Plan for Poliovirus Containment (GAP-IV, previously GAP-III) comes at the request of the WHO Containment Advisory Group (CAG) and streamlines the tool with other relevant WHO guidance and technical recommendations made by CAG. Its availability is expected to help accelerate containment implementation worldwide.

Containment involves biosafety and biosecurity requirements for laboratories and vaccine production sites, or any other place handling and storing eradicated polioviruses, to minimize the risk of these pathogens being released into communities. It also concerns risk mitigation measures associated with field use of some live oral polio vaccines. WHO urges facilities holding virus to move through its Containment Certification Scheme, and follow guidance contained in GAP-IV.

“Retention of poliovirus materials for what their governments deem to be critical functions is a risk and responsibility for all countries that choose to do so,” said Prof David Heymann, Chair of the CAG and professor of infectious disease epidemiology at the London School of Hygiene and Tropical Medicine. “GAP provides guidance that aims to minimize the risk of escape of the poliovirus from a retention facility, and we hope that the revised publication ̶ which stakeholders in polio eradication helped shape ̶ will ensure faster action by countries that decide to retain poliovirus materials,” he said.

“The revision of the guidance has been a long time in the making and comes with a lot of anticipation,” stated Dr Harpal Singh, WHO polio technical officer and CAG secretariat. “WHO and CAG have taken on board the numerous concerns and feedback from Member States with regards to carrying out the guidance, and a certain degree of flexibility based on local risk mitigation measures has been applied in some areas, whilst maintaining the rigor of evidence-based best practice,” he added. “We anticipate that this will result in a better implementation of the requirements for Member States opting to retain [poliovirus] materials, and having their facilities certified,” he added.

To date, two of three strains of wild poliovirus have been declared globally eradicated – type 2 and type 3. Countries around the world, however, continue to handle and store these viruses for functions including polio vaccine manufacture, diagnostics and research, among others. It is essential that any facility holding poliovirus types 2 and/or wild or VDPV type 3 stocks, regardless of purpose, either put in place the necessary biorisk management measures outlined in GAP or destroy their virus stocks.

“The world is on the precipice of eradication of wild poliovirus type 1 with the lowest ever case count recorded in 2021, and we got rid of WPV2 and WPV3 in 2015 and 2019, respectively. While some progress has been made, we’re actually quite behind schedule in ensuring those two eradicated serotypes are properly contained, and more needs to be done in this regard,” said Aidan O’Leary, head of WHO’s polio eradication programme.

“Importantly, Member States all committed to accelerating poliovirus containment action in 2018 through a World Health Assembly Resolution,” he reminded. “WHO will continue to work with and encourage Member States to move on their targets, and reprioritize these actions. Failure to do so not only heightens but prolongs the risk of the reintroduction of virus, the effects of which could be devastating,” he added.

There are currently 25 countries hosting 65 facilities officially designated by their respective governments to retain poliovirus materials. The majority of countries have established a National Authority for Containment for domestic oversight over containment action, in line with commitments from the 2018 resolution, and work is underway to progress their facilities through the Containment Certification Scheme.

For now, containment measures apply to all type 2 and wild and vaccine-derived type 3 materials.

More on Containment.

Leaders at this week’s G7 Head of State meeting in Germany and last week’s Commonwealth Heads of Government meeting in Rwanda renewed global commitment to polio eradication. In their official Communiqué, the Leaders of the Group of Seven (G7) vowed to ‘continue our support for polio eradication through the Global Polio Eradication Initiative’, while the Commonwealth Heads of Government, in their joint Communiqué on ‘Delivering a Common Future’, urged the continued intensified effort to eradicate polio, even amid other pressing health and development issues. These calls and commitments follow similar engagements made at previous global political fora this year, notably the recently-held G7 Development and Health Ministers meeting, and the World Health Assembly.

Global partners of the eradication effort, notably led by Rotary International and Rotarians around the world, are working with the public sector to ensure political commitments are fully operationalized.

In April 2022, GPEI partners, led by WHO Director-General, launched the ‘Investment Case for Polio Eradication’, the sister document to the Polio Eradication Strategy 2022-2026, which lays out the economic and humanitarian rationale for investing in a polio-free world, as well as the broader benefits of polio eradication.

In October 2022, Germany will generously co-host a global pledging moment, giving the international development community and polio-affected countries the opportunity to publicly re-commit to this effort, including to support a stronger and sustainably-funded WHO, so that the organization can maintain its capacity to support countries in achieving and sustaining polio eradication, and continue to benefit broader public health efforts, including support for pandemic preparedness and response.

The Global Polio Laboratory Network (GPLN) has confirmed the isolation of type 2 vaccine-derived poliovirus (VDPV2) from environmental samples in London, United Kingdom (UK), which were detected as part of ongoing disease surveillance. It is important to note that the virus has been isolated from environmental samples only – no associated cases of paralysis have been detected. Recent coverage for the primary course of DTaP/IPV/Hib/HepB vaccination, which protects against several diseases including polio, in London suggests immunization coverage of 86.6%.

Initially, vaccine-like type 2 poliovirus (SL2) had been isolated from samples taken from the same site between February and May 2022. Genetic analysis suggests that the new VDPV2 and previous SL2 isolates have a common origin, still to be identified, but the technical definition and criteria for ‘circulation’ of VDPV2 are not met at this time. Additional sewage samples collected upstream from the main waste-water treatment plant’s inlet are being analysed.

Investigations and response by the UK Health Security Agency are ongoing to:

assess both origin and risk of circulation associated with these isolates;
strengthen poliovirus surveillance including enterovirus and environmental;
explore routine immunization catch-up of children who are under-immunized, including of families that have recently arrived in the UK from countries with recent use of type 2-containing oral polio vaccine; and,
enhance communications about this incident to health professionals and caregivers.

It is important that all countries, in particular those with a high volume of travel and contact with polio-affected countries and areas, strengthen surveillance in order to rapidly detect any new virus importation and to facilitate a rapid response. Countries, territories, and areas should also maintain uniformly high routine immunization coverage at the district level and at the lowest administrative level to protect children from polio and to minimize the consequences of any new virus being introduced.

Dr. Nabil vaccinating administering polio drops to one of his grandsons in front of the community to convince people about the safety of the polio vaccine. © UNICEF Yemen — Dr. Nabil vaccinating administering polio drops to one of his grandsons in front of the community to convince people about the safety of the polio vaccine. ©UNICEF/Firdous

It’s been a long day for Dr. Nabeel Abdu Omar Ali. Since early morning, he has been going from one house to the next in a community in Aden, Yemen – listening to the concerns of parents and speaking to them about the importance of vaccination to save their children from polio. And he plans to continue till the sun goes down.

“The weather is pleasant now and I want to meet as many parents as possible, especially those who have concerns about vaccines. In a month’s time, the heat and humidity will be unbearable, making it difficult to walk from house to house,” says Dr. Nabeel.

Nicknamed “the mobile imam” by his peers, Dr. Nabeel is a pediatrician by profession, and a certified imam (Islamic teacher) from the Ministry of Endowment in Southern Yemen. He uses his religious knowledge and medical facts to educate the public about the importance of vaccination in protecting children from polio and other deadly diseases.

A few weeks back, he visited several families who were refusing vaccines in a nearby neighborhood. In addition to speaking to them about the safety and benefits of the polio vaccine, the ‘mobile Imam’ administered polio drops to his grandchildren in front of everyone at the community meeting.

“When the people saw a doctor and Imam like me vaccinating my own grandchildren, I think it was easier for them to believe that the vaccine was safe for their children too,” says Dr. Nabeel with a smile.

Reaching out to other Imams for support

Dr. Nabeel frequently reaches out to other Imams, training them about the benefits of vaccination and encourages them to share with the public during their Friday sermons.

Dr. Nabeel accompanying a polio vaccination team from one house to the next to speak with parents and caregivers. © UNICEF Yemen — Dr. Nabeel accompanying a polio vaccination team from one house to the next to speak with parents and caregivers. ©UNICEF/Firdous

“Imams are very influential in our communities – to raise awareness, shape social values, and promote positive attitudes, behaviours and practices. For example, a single sermon is powerful enough to change misconceptions about vaccines in some communities. If Imams are fully equipped with accurate information, it goes a long way in build trust and creating vaccine acceptance among the people – helping children in the community to stay health and free from polio and other vaccine-preventable diseases,” he adds.

The ongoing conflict in Yemen has severely damaged the health and basic infrastructure. There are frequent interruptions in power supply, and this often creates suspicion among community members as well as Imams whether vaccines are being stored safely.

“I was training a group of imams and they shared their doubts about the safety of the vaccine. They were skeptical about how refrigerators could store polio vaccines safely when there are so many power cuts in the area.”

In response, Dr. Nabeel organized a tour for the group to a vaccine storage facility where they were able to see and learn about special refrigerators that are powered by solar energy when there are power cuts.

Promoting the benefits of vaccination for over a decade

Dr. Nabeel has been working for the immunization programme in Yemen for over 12 years, partnering with UNICEF for numerous polio vaccination campaigns and routine immunization services.

When he first started out as pediatrician, he met many children who were paralyzed by polio. He felt frustrated that so many children would have to suffer for the rest of their lives by a disease that could have been easily prevented by a vaccine. That is when he decided to dedicate his time to educate caregivers and parents on the benefits of vaccination.

Dr. Nabeel (third from left) speaking with male members of a local community on the benefits of vaccination for children’s health and well-being. Photo: ©UNICEF Yemen — Dr. Nabeel (third from left) speaking with male members of a local community on the benefits of vaccination for children’s health and well-being. Photo: ©UNICEF/Firdous

“There are many misconceptions about vaccines. Throughout my career I have been confronted by people who were resistant to the idea of vaccination. Some people think that the vaccine will make them infertile, while others believe it’s some kind of a conspiracy. However, my many years of work in immunization and knowledge of religious scriptures has proven to be valuable so far in building trust in vaccine in communities,” says Dr. Nabeel.

The ‘mobile Imam’ is also quite adept in working with the media to promote vaccination. He is often seen and heard on TV and radio talk shows speaking about the benefits of vaccination and answering to questions from concerned parents and caregivers.

“I use a mixed approach to address vaccine hesitancy and dispel misinformation about vaccines. Sometimes it is helpful to talk about vaccines during Friday sermon, while other times, it is more effective to explain to a caller on a radio programme why vaccines are important,” he explains with a smile.