Port Sudan, Sudan – Sudan’s Federal Ministry of Health (FMOH) will launch a polio vaccination campaign in April 2024 in response to a new emergence of variant poliovirus type 2 reported in January 2024. It was detected in six wastewater samples collected from September 2023 to January 2024 in the Port Sudan locality, Red Sea State.

The FMOH, with support from the World Health Organization (WHO), has completed field investigations and a risk assessment to determine the extent of the virus circulation. Preparations for a polio vaccination campaign in April 2024 in Red Sea, Kassala, Gedaref, River Nile, Northern, White Nile, Blue Nile and Sennar states are under way, with a differentiated approach for the rest of the states as conditions allow.

Read more on the WHO EMRO website.

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

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

Read more on the WHO EMRO website.

Influencers from the French gaming community holding PSG scarfs made to support the #ENDPOLIO campaign
  • The Global Polio Eradication Initiative and the Paris Saint Germain Endowment Fund (PSG) call for one last push in the fight to eradicate polio
  • Renowned footballers, influencers from the French gaming community, Bill Gates, co-chair of the Bill & Melinda Gates Foundation and Emmanuel Macron unite to create excitement among the younger generation
  • An innovative activation resulted in the creation online of the gamer, “@P0L__10” —a pseudonym for polio— as all corners joined forces in the fight against the disease at the Gustave Eiffel Lounge on the first floor of the Eiffel Tower

PARIS (6 December): Last night, the French gaming community made a call for collective action to defeat a common adversary – only it was not an online gaming threat, but poliovirus, a debilitating infection that has been paralysing children for centuries.

Throughout the event, gamers battled on the EA SPORTS FC 24 pitch in a tournament to determine who would be the player chosen to defeat @P0L__10, a seemingly unbeatable opponent who had been tormenting players online in the preceding days. As the challenger was decided, it was revealed that this common adversary, @P0L__10, was in truth an alias for polio, a persistent foe that the world is on the brink of eradicating.

Since the Global Polio Eradication Initiative was formed in 1988, cases of the once ubiquitous polio have fallen by over 99%, and today the wild virus is confined to pockets of just two countries – Pakistan and Afghanistan. Still, poliovirus continues to threaten millions of children around the world, and until we stop all forms of polio everywhere, we all remain at risk. Thankfully, because this virus has been eliminated in most places, younger generations in much of the world have never witnessed this highly infectious and devastating virus impact on their friends and family members. 

Participants being introduced ahead of the EA Sports FC24 tournament

“As long as this virus continues to exist anywhere, young people everywhere, including here in France, remain at risk,” said Les Twins, a famous duo of Franco-American content creators on FC24, who hosted and broadcast on their Twitch channel (229K subscribers) Tuesday evening’s event at the Salle Gustave Eiffel, on the first floor of the Eiffel Tower. “The young, vibrant esports community in France is strong and capable, and tonight we showed that when we rally behind a cause we can make great things happen.”

“Gaming is important, but not as important as the lives of children around the world. This is our generation’s chance to really make a difference”, said Arsène Froon, Paris Saint-Germain (PSG), host whom the tournament’s winner was given the chance to challenge after the audience discovered he was hiding behind the character of P0L__10. Arsène delivered his message to an audience that included not just influential figures in gaming, but also PSG players from the female team, Ana Vitória, Océane Toussaint and Constance Picaud, e-players Nkantee and Amarr as well as European polio advocates. Our commitment to this cause is also a homage to Guy Crescent, the pioneer and founder of PSG, who himself was affected by poliomyelitis and contributed greatly to the club’s development.

French President Emmanuel Macron and Bill Gates, co-chair of the Bill & Melinda Gates Foundation, spoke to the crowd via video as polio was revealed to be the true adversary, echoing the sentiment that it is only with collective support and action that the eradication of this disease can be achieved. Just hours before the event, the Agence Française de Développement (AFD) announced up to €55 million in support to Pakistan, filling a critical funding gap in the country’s commitment to stop polio. These funds build on France’s monumental pledge of €50 million at the 2022 GPEI Pledging Moment in Berlin.

Photo of Emmanuel Macron and Bill Gates’ video played during the event

The vibrant event was a testament to the power of collaboration across sectors, bringing together the worlds of gaming, sport, and health advocacy in an historic collaboration, by captivating and engaging the younger generations to work together to end @P0L__10 and continue the fight to make polio history.

Further voices have joined the movement, including Gims, the Congolese-French singer, rapper, and activist who added, “I am super excited to join the efforts of Bill Gates, the Global Polio Eradication Initiative, and government leaders in the mission to eradicate polio in the Democratic Republic of Congo and around the world. Together, we will end polio and save tens of thousands of children from this devastating disease.”

About GPEI

The Global Polio Eradication Initiative is a public-private partnership led by national governments with six partners – the World Health Organization (WHO), Rotary International, the US Centers for Disease Control and Prevention (CDC), the United Nations Children’s Fund (UNICEF), Bill & Melinda Gates Foundation and Gavi, the vaccine alliance. Its goal is to eradicate polio worldwide.

For press inquiries, please contact Jacob Baskes, jbaskes@globalhealthstrategies.com

About the PARIS SAINT-GERMAIN FOUNDATION AND ENDOWMENT FUND: 

Since its creation in 2000, the Paris Saint-Germain Foundation has sought to help disadvantaged and sick children and deprived communities. It organises educational and sport programmes in France and around the world that use sport and its values as levers for learning, self-fulfilment and solidarity. In 2013, the Paris Saint-Germain Foundation set up an endowment fund to collect donations made by individuals and companies to help it develop its social responsibility and community programmes. Through these programmes, which enable disadvantaged people to integrate into society and the world of work, and through its Red and Blue Schools, its support for refugees and its charity donations, the Paris Saint-Germain Foundation harnesses the educational and emotional benefits of sport to come to the aid of people in need.

For press inquiries, please contact: Sarah Machkor, smachkor@psg.fr

By Aidan O’Leary, Director for Polio Eradication, World Health Organization, and
Chair of the Global Polio Eradication Initiative Strategy Committee

2023 is a critical year for the Global Polio Eradication Initiative (GPEI).  It is the target year to interrupt all remaining wild poliovirus type 1 (WPV1) and circulating vaccine-derived poliovirus type 2 (cVDPV2) transmission chains, per the GPEI Polio Eradication Strategy 2022-2026.  A rigorous independent review will be undertaken by the third quarter of 2023, to assess whether the programme is on track to meeting Goal 1 and Goal 2 of the Strategy:  permanently interrupt all poliovirus transmission in endemic countries; and, stop transmission of cVDPV2 and prevent outbreaks in non-endemic countries.

Despite the detection last year – the first operational year of the Polio Eradication Strategy – of several high-profile polio emergences, including in places such as New York and London, 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.  A unique, but limited, epidemiological window of opportunity exists at the beginning of 2023.  Key to success is reaching remaining ‘zero dose’ children (children who are either un- or under-vaccinated) in seven, subnational ‘most consequential geographies’.  These geographies – eastern Afghanistan, the southern area of Khyber Pakhtunkhwa in Pakistan, Tete province in northern Mozambique, north-western Nigeria, eastern Democratic Republic of the Congo (DR Congo), northern Yemen and south-central Somalia – which now together account for 80% of all polio cases worldwide (WPV1 – 100%, cVDPV2 – 80% and cVDPV1 – 76%) over the past 12 months (as at 28 March 2023).

As the first quarter of 2023 draws to a close, the GPEI’s analysis is that the programme remains on track to interrupt all remaining wild poliovirus transmission in 2023 – both endemically in Pakistan and Afghanistan, and in the outbreak setting of south-east Africa.  Not-withstanding the challenging operational contexts in eastern Afghanistan and the southern area of Khyber Pakhtunkhwa, intensified country efforts have resulted in a historically-low number of biologically-distinct virus lineages remaining in circulation and an ever-shrinking number of infected districts.

The situation with interrupting cVDPV2 transmission is more mixed.  Compared to other most consequential geographies, increased efforts in Nigeria have yielded positive results through 2022 and beyond.  The country’s main historical transmission chain, the Jigawa lineage, which was responsible for the majority of cases and international spread, appears to have been effectively halted.  New cases continued to decline in the second half of 2022. As a result, the virus is currently confined primarily to specific regions in the north-west.  In Somalia, where we have witnessed unbroken transmission since 2016, the numbers of inaccessible districts have been reduced to zero and inaccessible children to <80,000 by the end of the first quarter of 2023.

Polio Eradication Strategy 2022-2026 planning and budgeting timeline, 2021-2027+

In eastern DR Congo and northern Yemen, ongoing issues of access, acceptance and the delivery of high quality immunisation activities to maximise coverage remain concerning as both outbreaks continue to expand (including internationally) at the start of 2023.  Both contexts are protracted, complex humanitarian emergencies.  The programme at all levels is in the process of implementing a range of corrective course measures to urgently reverse this trend and get outbreak response in both contexts onto a footing to achieve success.  Pending the effective and sustained impact of these measures, it is unlikely that the end-2023 interruption target would be successfully met.

Independent review to provide clearer and independent assessment of status

At the time of the launch of the GPEI Strategy, a commitment was made to undertake a rigorous review of its implementation.  This review will be conducted by the Independent Monitoring Board (IMB), an independent group of public health experts established at the request of the World Health Assembly in 2010, to monitor and independently verify progress towards the achievement of a lasting polio-free world.

The IMB has a long history in evaluating the GPEI’s cross-cutting work, and recommending measures to help strengthen strategic approaches.  Its long-standing and independent input and analyses has over the years significantly contributed to sensitising strategic approaches.  At the same time, again thanks to its long-standing engagement with the GPEI, IMB members have in fact become ‘polio’ experts, and not simply public health experts.

The independent review now planned will be geared specifically to:

  • evaluate progress towards Goals 1 and 2 of the Polio Eradication Strategy 2022-2026;
  • assess whether the strategic plan is a) on track, b) at risk, c) off track or d) missed; and,
  • identify areas where corrective action plans are required and evaluate the quality, implementation and impact of corrective action plans.

The GPEI will work closely with the IMB to ensure that it has all the necessary inputs, analytics and modelling required to inform its deliberations during a planned meeting during 11-13 July 2023.  The IMB is anticipated to present its findings and recommendations to the GPEI Polio Oversight Board (POB) for decision at its face-to-face meeting in September/October 2023.  Our collective aim is clear – to redouble all efforts and focus on the critical path to zero and delivering on the promise of a polio free-world.

Martha Dodray is a health worker in the Kosi River Basin area of Bihar. In order to protect all children against polio, Martha has walked, waded, boated, and rode on motorcycles to reach the communities which are spread throughout the area. The region was one of the last to have polio transmission in India, which was certified polio-free in 2014. Kosi River Basin area near Darbhanga, Bihar State, India. November 2017.

India’s journey from the world’s epicentre of a highly infectious viral disease to turning polio-free was like walking on eggshells: Every step we took mattered.

On 13 January 2023, India completes 12 polio-free years – a remarkable achievement that was made as a result of consistent, determined efforts and genuine commitment at all levels.

I spent close to six enriching years of my life serving as the project manager of the National Polio Surveillance Project (NPSP) for WHO India. My work entailed providing technical assistance and strategic guidance to the national programme. I was also in charge of poliovirus surveillance, monitoring mass vaccination campaigns, crafting corrective measures and strategies, and working closely with government counterparts at all levels to ensure every child was vaccinated enough times to build their immunity. We delivered around 1 billion doses of polio vaccine to 172 million children each year over the course of four years leading up to the last case. And many more in the years after.

Taking a step back to reflect on this journey, there were several factors contributing to the monumental success of ending polio in India. The first fundamental factor was government commitment that consistently translated into diligent administrative action at the operational level. Even the district administrators were fully aligned with and committed to taking corrective measures based on evidence: accepting programmatic gaps and challenges and then committing to addressing them urgently.

Read more on the EMRO website.

Around the time when the Fédération Internationale de Football Association (FIFA) World Cup tournament was introduced, in 1930, children didn’t have access to polio vaccines. Additionally, systems to search for polio symptoms in children were most likely weak across the world. This scenario has changed now.

To prepare for an estimated 1.2 million football fans congregating in Qatar to watch the World Cup tournament, the Government of Qatar took several measures to mitigate risks associated with the spread of diseases, including polio. As part of these interventions, the country requested the World Health Organization (WHO) for technical support to assess and improve surveillance for polio.

Taking stock of existing disease surveillance systems

To kick off these efforts, after months of joint planning and coordination, a team from WHO’s Eastern Mediterranean Region (EMR) visited Qatar at the end of September 2022 to conduct an elaborate review of the surveillance system for acute flaccid paralysis (AFP). They examined activities at four main health care facilities − where both Qataris and visitors in the country frequently visit − to assess their contribution to AFP surveillance.

© WHO

The team also conducted a virtual capacity development session for more than 200 public and private health professionals to understand the global and regional polio situation, and the importance of AFP surveillance and case reporting.

Reviewing systems to detect and respond to polio cases

On noting the recent spread of polioviruses across the world, and ease with which viruses can be transmitted, WHO sensitized officials at the Ministry of Public Health on the standard operating procedures for polio outbreaks. This includes a template to develop a national preparedness plan for a polio outbreak.

As next steps, the team conducted a Polio Outbreak Simulation Exercise (POSE), to test the level of preparedness and the blueprint of activities that should be conducted in case of an outbreak. The POSE ensures users are aware of activities to conduct within the crucial first 72 hours of confirmation of a polio outbreak. This exercise also aimed to ensure all existing tools in use are valid, and refreshed health officials’ knowledge on the different kinds of polioviruses that exist and vaccines that can be used to boost immunity.

Need to strengthen AFP case notification

One of the most highly developed countries in the EMR, Qatar has a state-of-the-art online health client database, which is used by 90 percent of health service providers. The country also uses unique codes for all residents regardless of their nationality, which helps them manage infectious disease outbreaks. Health facilities offer high quality of health care, which encourages communities’ uptake in health services. Taking this into account, the surveillance review revealed that the electronic health system in Qatar is able to track AFP cases once notified.

The country, however, faces challenges in the notification of AFP cases, largely due to the lack of a comprehensive list of diseases related to AFP in the electronic databases currently in use in health facilities and hospitals. Additionally, physicians lack awareness about AFP and case notification, which is attributed to Qatar being polio-free since 1990.

Recommendations for stronger surveillance of polio  

Recommendations made by WHO to the Ministry of Public Health are aimed at developing the capacity of staff to notify AFP cases early; conduct regular active search for children with AFP, including through active surveillance visits; and execute 60-day follow up examination for AFP cases. The WHO team also advised Qatar to maintain updated and functional AFP surveillance guidelines, and a national preparedness and response plan for polio outbreaks and response.

WHO also encouraged the Ministry of Public Health to set up a system for environmental surveillance to search for polioviruses in sewage and wastewater at prime sites across the country. This would help to cast a wider net to search for any poliovirus both in visitors and communities living in the country.

Qatar plays a key role in polio eradication

The Government of Qatar is a key partner in polio eradication efforts. Qatar’s Minister of Public Health, HE Dr Hanan Mohamed Al Kuwari has been serving as the co-chair of the Regional Subcommittee for Polio Eradication and Outbreaks in the Eastern Mediterranean Region since February 2022. In this capacity,
HE Dr Al Kuwari has been instrumental in shining the spotlight on the current status of polio in the Region and efforts needed to end polio by the end of 2023.

A polio worker administers the oral polio vaccine to a child in Karachi. Credit: @SalmanMahar

Polio is one of the world’s most devastating diseases. It mainly affects children under five and in one in 200 cases it results in lifelong paralysis. Amazing progress has been made in fighting polio globally: according to UNICEF, there were a reported 20,000 children paralysed by polio in Pakistan in 1994. By 2021, new paralysis cases had dropped to just one child. However, as long as just one child remains infected, all children are at risk.

Identifying and reaching unvaccinated children has been a challenge, but big data startups like Zenysis, in partnership with Pakistan government partners, are making inroads.

Vaccination data is only useful if it’s accurate

Abid Hasan is the project manager for Zenysis – a Gavi INFUSE pacesetter since 2017 – in Pakistan, and he explains the barriers to a more effective vaccination programme in the country:

“Data is like people, in that if data sets don’t talk to each other then they won’t work well. Zenysis gets data and data sets talking.”

Community health workers employed through Pakistan’s Polio Eradication Programme and the Expanded Programme of Immunisation go door to door to collect vaccination data, sometimes using datasheets, sometimes paper, sometimes recording data through WhatsApp. It can be difficult to track families with no formal address, or mobile communities with no fixed address. With 14 million children requiring a polio vaccination every two months, recording accurate data is a mammoth task.

The resulting data can be imperfect, with duplication a particular challenge. This is where Zenysis’s platform comes in. Zenysis software integrates, de-deplicates and harmonises more than 20 siloed datasets, including polio data, immunisation registries and population data.

Combined, the data can be used far more effectively for analysis and, importantly, action on the ground. The result? A new and improved vaccination plan, personalised for each vaccinator’s district – known as a microplan.

A Community Health Worker goes door to door during the August polio campaign to give children the oral polio vaccine. She finds a newborn zero-dose child and records that data into her register. Credit: @SalmanMahar
A Community Health Worker goes door to door during the August polio campaign to give children the oral polio vaccine. She finds a newborn zero-dose child and records that data into her register.
Credit: @SalmanMahar

Microplans help health workers target zero-dose children

The enhanced microplans provide health workers with granular information on each child in a region, including their vaccination status, age and address. This information can be used to identify individual children and highlight neighbourhoods where there are clusters of unvaccinated (zero-dose) children. This in turn means better use of time and energy, and better outcomes for communities.

The effect, explains Hasan, is seen in three key areas. “Firstly, the newmicroplans give community health workers the real picture. Second, frontline workers now have a plan to follow and are no longer using broad or inflated data that is hard to actionize. Third, this approach is measurable – when you reach a target, that goes into the system. With accurate data, you can really see the impact.”

Health workers on the ground have seen the difference. Sadaf, a community health worker for Polio, in Karachi, says: “Before the microplans the vaccinators were given a long list of children with duplicate entries in them, and they were extremely difficult to track. After receiving these microplans we can easily decide where to set up our outreach sites and mobilise children to bring them there for vaccination in a systematic manner.”

The impact has been impressive. Since January 2022, the Expanded Programme on Immunisation in the Sindh region has used the Zenysis platform to identify over 28,500 true zero-dose children in the region and vaccinate 12,724 of them with the aid of microplans. In March to June of this year, 3,854 zero-dose children were vaccinated with the help of the new microplans in the regions where they have been implemented.

Community Health Workers using Zenysis provided microplans to identify houses with zero-dose children in high risk areas of Karachi. Credit: @SalmanMahar
Community Health Workers using Zenysis provided microplans to identify houses with zero-dose children in high risk areas of Karachi.
Credit: @SalmanMahar

Gavi support has been vital in creating goals and driving change

Zenysis was part of Gavi’s INFUSE programme, which connects high-impact innovations with the countries that need them most. Hasan explains that for countries like Pakistan, the investment from Gavi is vital to enhance healthcare budgets, but also to help provide momentum and set goals for vaccination programmes.

Looking ahead, Zenysis is collaborating closely with government partners to expand the platform and vaccination approach throughout Sindh province, tackle other vaccine-preventable diseases, and improve the government’s technical platform management capacity.

As Hasan says, “Not everyone is a data expert – but if you can go on a platform, go into a dashboard, and see all your data into one workspace then you can reach a zero-dose child and their family, and get them vaccinated.”

And with each child vaccinated, we get a step closer to a world where infection by wild poliovirus is a thing of the past.

Reposted with permission from gavi.org

HRH Prince Charles observing the vaccination of children in a village on the outskirts of New Delhi. © Kiron Pasricha
HRH Prince Charles observing the vaccination of children in a village on the outskirts of New Delhi. © Kiron Pasricha

The Global Polio Eradication Initiative is deeply saddened by the passing of Her Majesty Queen Elizabeth II.  Her leadership, steadfastness and commitment to service was exemplary throughout her life, and made her a globally-respected moral voice for some of the most marginalized people in our world.  We wish to express our deepest sympathy to her family and of course to all the people of the UK and indeed the Commonwealth.

The UK, Commonwealth and indeed the Royal Family have long been a proud and important supporter to the global eradication effort, and none has arguably been a more committed advocate than His Majesty King Charles III.  While still HRH Prince of Wales, Charles III engaged personally in this effort, adding his voice and commitment to ensuring children around the world are fully protected from lifelong polio paralysis.

In October 2003 in India, HRH Prince Charles participated in Polio National Immunization Days, observing the vaccination of children in villages on the outskirts of New Delhi.  In 2018, at the Commonwealth Leaders Summit, HRH Prince Charles highlighted the polio programme as an example of successful, joint action against disease, noting that hundreds of millions of children have benefitted from polio vaccination thanks to the Global Polio Eradication Initiative.  In 2013, during another visit to India, he acknowledged Rotary’s tremendous efforts in eradicating polio in India, as he accepted and posed with a Rotary ‘End Polio Now’ scarf for media photographers.

The Global Polio Eradication Initiative would like to extend our very best wishes to His Majesty King Charles III, for a long and successful reign.  Under his leadership, and indeed the UK and the Commonwealth’s, the effort to eradicate polio will continue unabated until our common goal of achieving a lasting world free of all forms of poliovirus is fully achieved.

The discovery in the summer of 2022 that poliovirus had been found in sewers in London as well as in an unvaccinated community in New York startled many who had long forgotten about polio. The outbreak was a perfect demonstration that vaccines are often so successful at stopping deadly diseases, that we can be lulled into a false complacency.

Although the disease is now endemic only in Afghanistan and Pakistan, it was a dangerous childhood disease across the world for much of the late 19th and early 20th centuries. Although polio vaccines were introduced as routine immunisations in the 1970s, which reduced cases substantially, by the late 1980s, polio still was paralysing over 1,000 children a day.

In 1988, the launch of Global Polio Eradication Initiative (GPEI, of which Gavi is a member) had a galvanising effect on efforts to eliminate the disease, bringing together governments, donors, local communities and health workers in a joint effort to raise awareness of the disease and widen access to polio vaccines.

Cases began to drop dramatically and are down 99%, with most countries having zero cases. An estimated 20 million children have been prevented from getting polio since the GPEI was launched. When Nigeria was declared free of wild poliovirus in 2020, it was a major achievement: it had been one of the last few countries where the disease had clung on.

As remarkable as these successes have been, polio experts warn that there is no room for easing off on eradication efforts until the world is polio-free. Infectious diseases that are nearly wiped out can bounce back with alarming ease when the global circumstances change – measles rates have started climbing in the past few years as vaccination rates have fallen in Europe and the US.

Uneven polio vaccine coverage across the world, compounded by the COVID-19 pandemic’s toll on routine immunisation worldwide, has meant the disease has popped up in unexpected places. In October 2021, Ukraine saw an outbreak, followed by a case of wild poliovirus in February 2022 in Malawi. In March, vaccine-derived polio was spotted in Israel, and in Pakistan, where the disease is still entrenched, more polio cases were recorded in the first quarter of 2022 than in the whole of 2021.

Although polio only affects a handful of countries currently, the potential threat from its continued circulation means that the World Health Organization still classifies it as a Public Health Emergency of International Concern (PHEIC) despite this classification being given back in 2014.

An ancient disease

Polio is one the world’s oldest diseases – 14th century Egyptian engravings have been found depicting a priest with a withered leg, the trademark of a disease that can paralyse the leg, leading to muscle weakness and shrinking. The British physician Michael Underwood produced the first clinical description of the disease in 1789. In 1840, the German orthopaedic doctor Dr Jacob Von Heine understood that poliomyelitis was a distinct disease from other forms of paralysis and theorised it had an infectious cause. The poliovirus that causes the disease was identified in 1909 by Austrian immunologist Karl Landsteiner.

The disease is caused by a highly infectious virus that spreads when people ingest food or water contaminated by human faeces, or through poor hygiene. Because of this it is common in areas where there is poor access to clean water and sanitation.

The virus mostly affects children. Around 70% of infections are asymptomatic or cause mild symptoms such as headache, fever, and neck stiffness, but it can also invade the nervous system and cause paralysis and, in extreme cases when the person’s breathing muscles are paralysed, it can kill. In some survivors, the nerve damage can cause post-polio syndrome, a disorder in which they may have muscle weakness that deteriorates over time, causing pain and fatigue and leaving them disabled.

There are three wild types of poliovirus (WPV) – type 1, type 2, and type 3. Type 2 was declared eradicated in September 2015, with the last case detected in India in 1999. Type 3 was declared eradicated in October 2019, having last been detected in November 2012. Type 1 remains in Afghanistan and Pakistan.

Vaccine development

There are two types of polio vaccines – an inactivated (killed) polio vaccine (IPV) developed by Dr Jonas Salk and first used in 1955, and a live attenuated (weakened) oral polio vaccine (OPV) developed by Dr Albert Sabin and first used in 1961.

IPV is made from inactivated wild-type poliovirus strains of each type; it is an injectable vaccine and in many countries is given with other routine childhood immunisations such as against diphtheria, tetanus and pertussis.

OPV consists of a mixture of live attenuated poliovirus strains of each of the three serotypes. It is safe and effective, however, the use of OPV in areas with poor water and sanitation can occasionally have an unwanted side effect – the live vaccine-virus shed by vaccinated individuals can in very rare cases mutate and spread in communities that are not fully vaccinated against polio.

The lower the population immunity, the longer the vaccine-derived virus can spread. This version of the virus can sometimes regain its ability to damage the nervous system and lead to paralysis – this is called a circulating vaccine-derived poliovirus (cVDPV).

Although IPV is an effective vaccine and valuable in countries with zero incidence of polio, it is better used as a precaution, since it does not trigger the same immune response as OPV and therefore is not as effective in stopping active poliovirus transmission. OPV induces mucosal immunity in the intestine, the primary site where poliovirus replicates – in this way, the vaccine prevents shedding of the virus into the environment and can limit or stop person-to-person transmission. This is critical in communities with poor water and sanitation, where people are more likely to be exposed to water-borne pathogens.

Thus, although IPV has has recently been introduced into routine immunisation programmes in Gavi supported countries, OPV is still needed in countries where transmission needs to be stopped.

The last mile to eradication

The polio eradication effort was badly hit by the pandemic, but is now regaining ground. One new weapon in the arsenal is a new vaccine – the novel oral polio vaccine (nOPV2) – which has been modified to be more genetically stable than the Sabin strain and less likely to cause cases from vaccine-derived virus.

In November 2020, nOPV2 received a recommendation for use under WHO’s Emergency Use Listing (EUL) procedure to be able to roll it out rapidly. As of June 2022, approximately 370 million doses of nOPV2 have been administered in 20 countries – including Benin, Cameroon, Congo, Djibouti, Egypt, Ethiopia, The Gambia, Guinea-Bissau, Liberia, Mauritania, Mozambique, Niger, Nigeria, Senegal, Sierra Leone, Tajikistan and Uganda.

The high demand for this vaccination, however, is causing a supply constraint that the GPEI is working to ease. The GPEI advises that in situations where there is co-circulation of poliovirus strains, trivalent oral polio vaccine (tOPV) may be the best choice of vaccine.

Considerable challenges remain in eradicating polio in the two endemic countries. In Pakistan, difficulties in accessing high-risk mobile communities remain, and this is exacerbated by people refusing to get their children vaccinated because of misinformation or community fatigue, as well as low routine immunisation coverage in some parts of the country.

Afghanistan shares many of these challenges, including vaccine hesitancy, with the added challenge of decades of conflict and insecurity leading to fragile health systems that are unable to sustain routine immunisations. This has meant that many communities are missed or under-vaccinated, leaving children at risk of polio.

Now that polio vaccination programmes have resumed, eradication efforts have stepped up, ramping up vaccine coverage by boosting vaccine supply and engaging the trust of communities to overcome misinformation and raise awareness of the need for the vaccine, which can mean bringing in community and religious leaders.

The last mile to ending polio has been in sight for years, but the pandemic has thrown progress off course. While the road to eradication remains challenging, the ability of polio to re-emerge unexpectedly proves the need to continue to strive towards ensuring a polio-free world. For now, the disease is endemic in two low-income countries; there is no guarantee it will stay that way.

Reposted with permission from: www.gavi.org/vaccineswork

 

As south-east Africa continues to intensify efforts to stop a wild poliovirus type 1 (WPV1) outbreak detected in Malawi in February, the Africa Regional Certification Commission for Polio Eradication (ARCC) – the independent regional advisory body guiding Africa’s eradication effort – called for urgent action to stop all forms of poliovirus affecting the continent, be it wild or variant.

Reviewing the regional epidemiology at its bi-annual meeting on 6 June, the ARCC commended the governments’ commitments in Malawi, Mozambique, Tanzania and Zambia, in launching a series of emergency outbreak response campaigns, in response to the detected WPV1 in February.  With two campaigns already implemented, further activities planned later in the summer will also feature Zimbabwe participating in the subregional outbreak response effort.  The campaigns are supported by partners of the Global Polio Eradication Initiative (GPEI), notably WHO, UNICEF, BMGF, US CDC, GAVI, and local Rotarians, and by the Africa Rapid Response team.

The ARCC put forward four key recommendations to help ensure the outbreak can be rapidly stopped, namely:

  • implementing plans to improve campaign quality, based on lessons learned and quality-response assessments from the initial two rounds;
  • assessing WPV1 risks for older age groups and, as appropriate, expand target age groups of further outbreak response;
  • further expanding and strengthening subnational surveillance sensitivity to more clearly assess potential spread of this outbreak and eventually verify that the outbreak has been successfully stopped; and,
  • implementing surveillance-focused assessments in all five participating countries.

Commenting on the outbreak response and the group’s deliberations, ARCC chair, Professor Rose Leke said: “Countries must be reminded that wild poliovirus is endemic in Afghanistan and Pakistan, and south-east Africa is now infected.  The risk of poliovirus being re-introduced or re-emerging is high, and the best thing countries can do to minimize the risk and consequences of polio is to strengthen immunity levels and subnational surveillance sensitivity.”

Countries, supported by GPEI partners, are also intensifying efforts to stop a number of variant poliovirus outbreaks in the Region, notably in Nigeria, the Democratic Republic of the Congo (DR Congo) and other areas.  To combat this development, the ARCC encouraged partners and countries to prioritize the new novel oral polio vaccine type 2 (nOPV2) supply to highest-risk areas.

“Novel OPV type 2 is an important new tool,” continued Professor Leke.  “But at the same time, it must reach the children it is intended to reach.  Variant polioviruses paralyze children and affect their families and communities in the same way that wild polioviruses do, and hence must be responded to with the same level of urgency and political commitment and oversight.”

Professor Leke and the ARCC members underscored the importance of building up routine immunization capabilities and surveillance sensitivity, both of which are critical in combatting a wide range of infectious diseases, including COVID-19 on the continent.  According to Professor Leke: “The decline of routine immunization in the Region is of particular concern and puts the most vulnerable children at an increased risk to diseases such as polio.”  An immunization and surveillance gap formed in many African countries due to the Covid-19 pandemic, as health workers were limited in routine activities by social distancing restrictions.  While national surveillance activities have been renewed, persistent gaps remain at subnational levels.  The various outbreaks across Africa in 2022 demonstrate that surveillance and routine immunization activities must be improved.

In its concluding remarks, the ARCC noted with appreciation critical milestones achieved, including the recent successful closure of 32 outbreaks from ten countries, at the end of Q1 2022, clearly demonstrating that outbreak response strategies work when fully implemented and resourced.  “We have the opportunity of reaching zero polio cases,” concluded Professor Leke, “but only if we reach the remaining zero-dose children.  Let us all focus our efforts on that, and if that happens, success will follow.”

On International Women’s Day, Spanish Minister for Foreign Affairs, European Union and Cooperation and Gender Champion for Polio Eradication, José Manuel Albares pays tribute to all the women in polio eradication across the world  and reminds us that women are still underrepresented in senior leadership and decision making roles in global health and that these gaps in leadership are driven by stereotypes, discrimination and power imbalances that we are all responsible to tackle.

Cairo, 10 February 2022 – The fourth meeting of the Regional Subcommittee on Polio Eradication and Outbreaks was convened on Wednesday 9 February, by WHO’s Regional Director for the Eastern Mediterranean Dr Ahmed Al-Mandhari. The meeting was attended by health ministers or their representatives from Djibouti, Egypt, the Islamic Republic of Iran, Pakistan, Qatar, Saudi Arabia, Sudan, United Arab Emirates and Yemen.

The Subcommittee declared the ongoing circulation of any strain of poliovirus in the Region to be a regional public health emergency and called on all authorities to enable uninterrupted access to the youngest and most vulnerable children through the resumption of house-to-house vaccination campaigns. It issued statements on wild poliovirus circulation in Afghanistan and Pakistan and on the circulation of vaccine-derived poliovirus strains in Yemen, where limits on house-to-house vaccination are preventing access to the most vulnerable children.

The spread of polio in the Eastern Mediterranean Region is a pressing emergency and it remains a Public Health Emergency of International Concern (PHEIC) under the International Health Regulations (IHR 2005).

Members noted a sharp decrease in cases of wild poliovirus in Afghanistan and Pakistan in 2021 but warned against complacency.

“Wild poliovirus transmission is at a historic low in the endemic countries of Afghanistan and Pakistan. The progress is remarkable, but it is fragile. The opportunity to end polio is knocking at our door, and we must seize it,” said Dr Al-Mandhari.

Speaking to the progress made in the last year, the Special Assistant to the Prime Minister on Health, Dr Faisal Sultan, assured members that the programme in Pakistan was leaving no stone unturned in the pursuit of zero polio transmission.

“We have intensified efforts in the hardest districts and core reservoirs and we are closely monitoring transmission across the border in coordination with Afghanistan, taking measures to respond to outbreaks if they occur and making every effort to ensure that the virus doesn’t spill over in either direction. To boost the confidence of marginalized communities, we are also providing essential services and vaccination of other antigens and diseases,” he said.

Outbreaks of circulating vaccine-derived polioviruses type 1 (cVDPV1) and type 2 (cVDPV2) continued to emerge and spread in the Region in 2021. As of February 2022, Afghanistan, Djibouti, Egypt, Pakistan, Somalia, Sudan and Yemen are responding to transmission of vaccine-derived polioviruses.

“The increasing outbreaks of circulating vaccine-derived poliovirus type 2 in the Eastern Mediterranean Region and neighbouring countries of Africa are deeply concerning and must be stopped rapidly. To do so, we need to ensure that we are creating an enabling environment for health workers to reach children with those two drops of polio vaccine,” said newly nominated co-chair H.E. Dr Hanan Mohamed Al Kuwari, Minister of Public Health of Qatar.

During the meeting, Djibouti’s Public Health Minister, Dr Ahmed Robleh Abdilleh, shared plans for vaccination campaigns and increased surveillance in response to the transmission of cVDPV2, recently detected through the newly launched environmental sampling programme.

Reflecting on the work of the Subcommittee, co-chair and Minister of Health and Prevention of the United Arab Emirates H.E. Abdul Rahman Mohammed Al Owais urged members to sustain the commitment seen in in 2021.

“We have together advocated for an increase in domestic funds, we have driven collaborative public health action in our own countries, and collectively pushed for a regional response to address the regional public health emergency of the poliovirus. But these things alone will not end transmission,” he said.

Dr Al-Mandhari expressed appreciation for Egypt’s role as the first country in the Region to roll out a nationwide vaccination campaign using the novel poliovirus vaccine, and Chris Elias, Chair of the Polio Oversight Board, praised the remarkable progress made in polio eradication in Pakistan with support of the United Arab Emirate’s Pakistan Assistance Programme.

“This regional solidarity and commitment we have seen, through this Subcommittee, is something I am proud of. It is this commitment to the end goal that will help push us over the last mile,” said Dr Hamid Jafari, director of the regional polio programme and co-facilitator of the Regional Subcommittee.

The Executive Board Room at WHO Headquarters during the 150th EB session. © WHO

January 2022, Geneva, Switzerland – As the world enters 2022, and with it the year when the new GPEI Strategy 2022-2026 – Delivering on a Promise – takes effect, global public health leaders at this week’s WHO Executive Board urged for intensified eradication efforts to capitalize on a unique epidemiological window of opportunity.  2021 saw the lowest ever levels of wild poliovirus cases in history, with five cases reported from the remaining two endemic countries, Pakistan and Afghanistan.  Cases of circulating vaccine-derived poliovirus have also declined compared to 2020.

Delegates attributed this favourable situation to sustained commitment from the highest levels in polio-affected areas, but issued severe warnings against complacency.  “2021 set the stage for success,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus.  “We must now not lower our guard.”

“What is clear is that in 2022, we have a very real and realistically achievable opportunity to finish wild poliovirus from the world once and for all,” said Aidan O’Leary, Director of the Global Polio Eradication Initiative, WHO.  “But what is equally clear from the discussions at the Executive Board is that there is virtually no room for error now.  If we take our foot off the accelerator even by a little bit, this virus will come roaring back, and we will perhaps have lost the best chance yet for success.  The resounding message from this week’s meeting is this:  we cannot allow this to happen.  Success is the only acceptable outcome.”

Time and again, delegates, experts and partners such as Rotary International underscored the need to fully implement and finance the GPEI Strategy 2022-2026, highlighting that it clearly laid out the roadmap to achieving a lasting world free of all forms of polioviruses, through stronger community engagement, a renewed focus on gender equity and the rollout of new tools and technologies, including the novel oral polio vaccine type 2.

Delegates expressed appreciation at the polio programme’s ability to adapt to programmatic, epidemilogical and political developments, as demonstrated in Afghanistan last year, where – for the first time in more than three years – nationwide immunization campaigns resumed. At the same time, 2021 again saw the broader benefits of polio eradication, with health workers at the forefront supporting global COVID-19 response, vaccination and immunization recovery efforts, and the polio infrastructure now increasingly being integrated into broader public health systems in polio-free countries across the world. ​

With over 50 countries transitioning out of GPEI support in 2022, Member States also supported efforts to sustain the gains in polio-free countries, calling on WHO to continue its technical support in polio-free countries, and to ensure that polio assets, tools and expertise are effectively integrated into broader immunization, disease surveillance, primary health care, and outbreak preparedness and response efforts.

“Together with our partners at Rotary International, CDC, UNICEF the Bill & Melinda Gates Foundation and Gavi, the Vaccine Alliance, we will continue to support Member States in their eradication efforts,” concluded O’Leary.  “But much is on the line.  We have everything in place – we need to focus now fully on optimizing our tools and tactics, and ensuring the resources to do so are available.  If those two things come together, we will be able to give the world one less infectious disease to worry about once and for all.”

Watch this animation to learn how the Global Polio Eradication Initiative (GPEI) intends to reinvigorate polio prevention and outbreak response with the bold new GPEI Strategy for 2022-2026.

The funding will be used to vaccinate approximately 16 million children in 84 highest-risk districts. © UAE

The United Arab Emirates (UAE) on July 24 announced an additional US$9.5 million support to the Pakistan Polio Eradication Initiative (PEI). The funding will be used to vaccinate approximately 16 million children during door-to-door immunization campaigns in 84 highest-risk districts as well as an additional US$376,000 to provide personal protective equipment against COVID-19 for the frontline campaign workers.

The funding, which will be utilized from July to December, brings to more than US$23 million made available by the UAE in 2021. The Emirates, a long-time supporter of Pakistan’s polio programme and its main funder, has provided over US$200 million in financial support since 2014. Pakistan is one of two countries where wild poliovirus remains endemic.

Speaking on behalf of the Global Polio Eradication Initiative, Dr Palitha Mahipala, the World Health Organization Representative in Pakistan, thanked the UAE for its generous contribution, noting the UAE’s steadfast commitment not only to protecting children from lifelong paralysis but to the overall goal of polio eradication.

“The UAE has firmly stood by the polio programme with vital yearly contributions and in pleas for extra funding to address unforeseen challenges such as COVID-19,” he said. “This would not be possible without their support.”

Only one case of wild poliovirus has been reported in Pakistan in the first six months of the year, a significant decrease from the 59 cases reported during the same period in 2020. In order to be certified polio-free, Pakistan is required to report zero cases of wild poliovirus over a three-year period. The Government of Pakistan remains fully committed to reaching the goal of zero in the coming months.

The Emirates Polio Campaign plays an important role in driving eradication efforts at the frontline of Pakistan’s most vulnerable communities. © UAE

Through the Emirates Polio Campaign initiative, the UAE Pakistan Assistance Programme (UAE-PAP) plays an important role in driving eradication efforts at the frontline of Pakistan’s most vulnerable communities. In 2020, as part of the Emirates Polio Campaign, UAE-PAP support ensured close to 16 million children under five years of age received protection through repeated polio campaigns and all frontline workers in 84 districts received personal protective equipment and training to facilitate protection from COVID-19.

“The efforts and sacrifices of the field vaccination teams, who faced difficult field conditions and dangerous challenges, greatly contribute to the success of the campaigns and reducing the spread of poliovirus in the Islamic Republic of Pakistan,” said Mr. Abdullah Alghfeli, Director of the UAE-PAP.

Mr. Abdullah praised the humanitarian approach and the generous support of His Highness Sheikh Mohamed Bin Zayed Al Nahyan, Crown Prince of Abu Dhabi and Deputy Supreme Commander of the UAE Armed Forces, adding that His Highness’s humanitarian initiative to eradicate polio is a major factor contributing to the elimination of the disease.

Dr Shahzad Baig, National Coordinator of the National Emergency Operations Centre (NEOC) for polio eradication warmly welcomed the contribution as an important boost in ensuring the programme continued door-to-door polio campaigns, the most effective way of immunizing against the virus, and ending polio in Pakistan.

“We are getting closer to our goal but this is not the time to be complacent,” he warned. “We are re-doubling our efforts to ensure the gains of the past don’t slip away.”

On June 10 2021, the GPEI held a virtual event to launch the new strategy. Here is a recording of the event. The video is also available with subtitles in: French | Arabic |

Zubaida Bibi leads a team in Khyber Pakhtunkhwa province in the country’s north. © WHO/EMRO

Health interventions and immunization activities are most effective when delivered by women.  During each nationwide polio vaccination campaign in Pakistan, women make up around 62 percent of the 280, 000+ frontline workforce vaccinating millions of children across the country.

With each campaign depending on the dedication of staff to reach all children, given their trusted roles and responsibilities in communities, female polio frontline workers are playing a key role in eradicating polio.

Breaking barriers to immunization

After three years as a monitor of campaign activities, Zubaida Bibi has progressed from being a polio team member to a team leader in Khyber Pakhtunkhwa province in the country’s north, one of the most affected areas in Pakistan.

Breaking the gender-related barriers to immunization, Zubaida travels extensively including hard-to-reach areas. Not even the winter season, when the roads and tracks are covered with snow, deters Zubaida.

“I would always tell them that the polio vaccine is totally safe for their children,” says Shumaila Majeed at work in Lahore. © Hassan Raza

“It leaves us with no option but to travel for miles and hours on foot to reach the children,” she says “Despite the challenges, I always try and motivate my teams, telling them that we are on a national mission to save the future of our children,” she says.

“It gives me a feeling of gratitude and satisfaction when the community appreciates our efforts for improving the health of their children,” adds Zubaida.

Building trust

For nine years, Shumaila Majeed has worked as a community-based health worker in Lahore, with a firm belief in empowering women and supporting their important presence in the polio programme.

Mothers would frequently ask her about the safety of the polio vaccine. “I would always tell them that the polio vaccine is totally safe for their children and build their trust,” says Shumaila.

“It’s very important to have women in every walk of life,” she explains. “Not only because women and grandmothers feel more comfortable when their children are vaccinated but to give more opportunities for woman to grow and excel.”

Through her work Shumaila wants to give young girls a message: stay focused on their goals and leave no stone unturned to make their dreams come true.

Persuading parents

In Pakistan, a significant number of parents and caregivers still doubt the effectiveness of vaccines. Karachi has long been a core reservoir for the poliovirus, with continuous and intense circulation.

Shagufta Naz, a community-based health worker in charge of Gulshan town, has been working for 21 years to ensure all children in her area are vaccinated on time. “Initially, parents used to hide their children from us due to their fear,” she explains.

Shagufta Naz is a trusted source of information about polio for her community in Karachi. © WHO/EMRO

Everyone who works with Shagufta is immediately impressed by her great care, her attention to detail and her meticulous record-keeping which is key to achieving vaccination targets. As a result of Shagufta’s hard work, vaccine refusals have reduced significantly. Her work is now so highly regarded that some parents will only have their children vaccinated by Shagufta, asking for her by name with each polio campaign.

“I got to know the community very well, built their trust,” she explains. “I know every pregnant woman and can tell you when she is due. Now, mothers regularly ask me about the next vaccination campaign.”

Going against all odds

Gul Parana, a Tehsil Communication Officer for the polio eradication programme in Balochistan province in the country’s southwest, recently graduated with a master’s degree.

Assigned to raise awareness about the benefits of vaccination in Chaman District, one of the most challenging areas for the polio programme, she is proud of her work despite many challenges.

Gul Parana raises awareness about the benefits of vaccination in remote Chaman District in Balochistan province. © WHO/EMRO

“Since Chaman is a very remote and conservative area, it’s not easy for a young girl like me to go out of the house. Most of my friends are not allowed to work. But I have a mission to save our children and give them a healthy future,” she says.

With support of her family, Gul Parana has become a symbol of strength for the girls of her locality. “I want to inspire other girls so they can also get an education and work. We need to have equal opportunities for every girl in Balochistan,” she adds.

Egypt’s Minister of Health and Population, H.E Dr Hala Zayed, one of the elected co-chairs for the new subcommittee, making her interventions during the inaugural meeting on 16 March, 2021. © WHO/EMRO

The new Regional Subcommittee brings together ministers of health from Member States across the Eastern Mediterranean Region to tackle some of the persistent high-level challenges to polio eradication. Those include raising the visibility of polio eradication as a regional public health emergency and priority and mustering the political support and domestic financial support needed to finish the job.

During the inaugural meeting convened by the Regional Director, Dr Ahmed Al-Mandhari, two co-chairs were elected to drive the regional push: Egypt’s Minister of Health and Population, H.E Dr Hala Zayed, and the Minister of Health and Prevention of the United Arab Emirates, H.E. Abdul Rahman Mohammed Al Oweis.

H.E. Abdul Rahman Mohammed Al Oweis was represented at the meeting by Dr Hussain Al Rand, the Assistant Undersecretary for Health Centres and Clinics and Public Health, United Arab Emirates. Both Member States flagged the urgency of the state of polio transmission in the last polio-endemic region at present, but also the opportunity to leverage greater regional coordination to achieve eradication.

Polio eradicators around the world know that ours is, in many ways, a grassroots programme: we use microplans to work through neighbourhoods door to door, household to household. But big-picture solidarity is needed to maximize the success of our ground-level efforts.

Wild poliovirus transmission has spread beyond core reservoirs of polio endemic Afghanistan and Pakistan, infecting 140 children in 2020. Outbreaks of circulating vaccine-derived poliovirus type 1 (cVDPV1) paralysed 29 children in Yemen. Type 2 outbreaks spread across the Region in 2020, paralysing 308 children in Afghanistan, 135 in Pakistan, 58 in Sudan and 14 in Somalia. At a time like this, moving forward as a region and as blocs, rather than on a country-by-country basis, is critical.

One of the issues identified by Member States as critical to stopping transmission is the movement of people across borders, and ensuring that surveillance and vaccination efforts target the increasing number of people who regularly cross borders across the region – whether they are moving as a consequence of conflict, environmental crises or economic necessity.

Interventions were made by Afghanistan, Egypt, the Islamic Republic of Iran, Iraq, Oman, Pakistan, Saudi Arabia and the United Arab Emirates. All statements reaffirmed strong support for the establishment of the subcommittee under the Regional Committee Resolution on polio eradication adopted in 2020.

Members of the subcommittee were unanimous in their commitment to engage in coordinated action and support of regional polio eradication efforts in four strategic areas. These include raising the visibility of the polio emergency in the Region, pushing for collective public health action, strengthening efforts to transition polio assets and infrastructure and advocating for the mobilization of national and international funding to achieve and sustain polio eradication.

A theme that ran through all Member States’ interventions was the idea of maximizing the resources already in place – including the workers, the polio and EPI infrastructure a across the region, and the array of community leadership groups with which the polio programme has worked in past.

“Last year or the year before the year before there was a meeting in Muscat with religious leaders from different countries, and I think we need to capitalize on their support. We need to give them ownership,” said Dr Ahmed Al Saidi, Minister of Health, Oman.

The COVID-19 pandemic has had an outsized impact on polio programmes across the region. The four-month pause in vaccination, from March-July 2020, gave the virus a window to spread almost unchecked. While we are immensely proud to have shouldered much of the COVID response burden, with GPEI infrastructure still supporting that response, this has come at a cost: nearly 80 million vaccination opportunities were lost.

“But we are moving forward, making up lost ground and, through this new Regional Subcommittee, leveraging the credibility that the polio programme has built through its pivot to COVID-19 and back again to polio,” said Dr Hamid Jafari, Director of the regional polio programme and co-facilitator of the Regional Subcommittee.

That credibility is now the polio’s most valuable asset: the proof that polio programmes are not just a means to battle polio, but sophisticated, fast-moving public health assets skilled in pandemic response.

The subcommittee will report its progress to WHO’s governing bodies meetings, including the World Health Assembly and the Regional Committee for the Eastern Mediterranean.

The Secretariat, which is made up of the office of the Regional Director and members of the regional polio eradication programme from WHO’s Eastern Mediterranean Region, will support the subcommittee to develop a programme of work based on the key outputs of the group.

Press Statement following inaugural meeting.

In January

  • 39.6 million children were vaccinated during the NIDs campaign.
  • 1.1 M children were vaccinated at Permanent Transit Points.

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Heather meeting an all-women vaccinator team in Lao PDR. Over the last few years, she has played a crucial role encouraging members of the polio programme to “put on their gender glasses”. © Heather Monnet

Throughout her career as a Resource Mobilization Officer for WHO’s polio eradication programme, Heather Monnet has held onto her vision of a polio-free world. A respected communicator with a deep understanding of the polio programme, she was one of the first in the programme to realize that considering gender is crucial to defeat the poliovirus. Since 2017, she has successfully “led from behind”, supporting the Global Polio Eradication Initiative (GPEI) to develop a gender strategy and workstream which has become a model for other United Nations programmes, and which is designed to overcome some of the most intractable challenges facing polio eradicators.

Describing her motivation, Heather describes “putting on her gender glasses”. She explains, “We had reached a point where it seemed like we had turned nearly every stone to eradicate polio, and yet we had not defeated the disease. At the same time, the introduction of the sustainable development goals had led to an increasing awareness of gender. I began to think more about how gender affects health and health-seeking behaviors.”

“I was not, and am still not a gender expert, but as Member States began to speak more about this issue, it was increasingly on my radar. Putting on my “gender glasses”, I realized that gender was an unexplored intersection for polio eradication, and it could be transformative for our work.”

The case for considering gender

Heather holding a Rotary EndPolio bear, sold by UK Rotarians to raise money for polio eradication. © Heather Monnet

In polio eradication, areas where gender intersects with health delivery include exploring whether boys and girls are equally as likely to receive the polio vaccine, and if gender norms impact whether mothers are able to take their children to health centres for routine immunization.

In some places, such as in Nigeria, women are often more effective at delivering the polio vaccine than men, as it is more culturally acceptable for them to interact with mothers and enter homes to vaccinate the smallest children. The GPEI Gender Technical Brief showed how the presence of female health workers in Pakistan has been associated with substantial increases in tetanus vaccine coverage, attended births, and full immunization coverage of children.

To explore and respond to the gender dynamics of polio eradication, the GPEI has published a comprehensive gender equality strategy. A dedicated gender analyst works in the polio programme at WHO headquarters, and gender focal points have been appointed at regional levels and in some country offices. Data is now routinely disaggregated by sex, and there has been a concerted effort to use gender analyses to inform programme policy. The team are currently engaged in implementing the GPEI gender strategy as well as supporting efforts to mainstream gender across WHO, including through a dedicated gender data working group.

Advocating for consideration of gender within the programme has not always been easy. Heather explains, “The polio programme is huge and so many people are involved. Encouraging people to put on their ‘gender glasses’ even for five minutes can be a challenge. But what is really encouraging is that once we educate people about how gender impacts their work, they often have an “aha” moment.”

“The next and crucial steps are striving to ensure that the gender strategy is implemented. This requires all those involved in polio to be engaged – whether it’s designing a gender-inclusive microplan, collecting sex-disaggregated data during a campaign, or considering how gender impacts the way we pay vaccinators. As we integrate gender into our work, we also need to identify the building blocks to ensure that this workstream is sustainably mainstreamed. This is not dependent on one person – rather it takes everyone having exposure.”

Polio Gender Champions

The GPEI gender workstream is supported by Polio Gender Champions, who work to raise the voices of those engaged in the programme. Champions include Senator Hon Marise Payne, Australian Minister for Foreign Affairs and Minister for Women, Wendy Morton, Minister of European Neighbourhood and the Americas at the Foreign, Commonwealth & Development Office in the United Kingdom, and Arancha González Laya, who is the Spanish Minister for Foreign Affairs, European Union and Cooperation.

Heather explains that the vision and leadership of the gender champions is crucial for achieving change. “The gender champions amplify the voices of those who don’t have a megaphone on the global stage and whose voices need to be heard. For instance, female frontline workers have a lot to say, but their voices aren’t always listened to. Our gender champions raise up these voices from the field.”

The GPEI Gender Strategy outlines key intersections between gender and polio eradication and sets out a framework for mainstreaming gender into the programme. © WHO Afghanistan/Roya Haidari

“This feeds into our attempts to improve the way that health is delivered. We know that most healthcare is delivered by women, but the systems to deliver it are designed by men. Practical steps to support women employed by the programme may include ensuring that polio vaccination training materials can be understood by individuals with lower literacy, and ensuring that there are safe, private bathrooms available for women to use during long campaign days. When we plan routes to deliver vaccines from house to house, we should consider that women might prefer to take a different route which gives them a greater feeling of personal security. Women may not feel comfortable speaking about these issues to a male supervisor, so we must also ensure that enough female supervisors are recruited and trained. Gender champions are key to keeping these issues high on the global agenda.”

Over the last few years, the GPEI’s gender work has been recognized in multiple high-level forums, and is leading the way for other programmes. Heather identifies two moments when she felt particularly proud – when the Polio Oversight Board adopted and endorsed the GPEI gender strategy, and at a high-level meeting hosted by the Government of the United Arab Emirates in advance of the Reaching the Last Mile Forum in November 2019, during which the Canadian representative described GPEI’s gender strategy as one of the strongest in global health and noted that it should stand as an example for others.

Heather explains, “I have been inspired by what we have achieved – we have planted the seeds and the soil is now being nourished. Our work on gender is growing into something amazing – and the world is watching what it will become.”

Dr Olayinka’s work aims to overcome gender-related barriers to immunization and encourage women into the workforce. ©Folake Olayinka

Dr. Folake Olayinka has spent over 20 years working in public health, including at the frontline of efforts to eradicate polio and strengthen immunization.

“At local levels, where the rubber meets the road, we need to make things work. Frontline health workers should be supported with tools that meet their needs, and training that truly values their insights, local innovations and problem solving,” said Dr. Olayinka.

Today, as a global health leader and former John Snow, Inc. (JSI) Project Director for the USAID-funded MOMENTUM Routine Immunization Transformation and Equity Project, she continues to exchange lessons and innovative strategies from the frontlines with other parts of the world impacted by polio and low immunization coverage.

On August 25, 2020, Nigeria, previously the last stronghold of endemic wild polio in Africa, was officially declared free of wild poliovirus. One of the factors contributing to this success was the ability to provide high-quality capacity building and support to improve health workers’ competencies at all levels of the health system.

“The health workers on the frontlines – particularly the community-based workers, many of whom are women – are the backbone of all of these efforts. They operate under incredible circumstances to ensure that their communities have access to life-saving health services,” said Dr. Olayinka.

Dr. Olayinka began working on polio in 2002 in Nigeria. She worked closely with colleagues at the Nigerian Ministry of Health, the World Health Organization, the EU and UNICEF to ramp up health worker training in support of the Nigerian government’s National Program on Immunization.

Her team’s dedication was remarkable. “We were willing to go everywhere to reach the last child. Once I walked four hours to support an immunization team,” she recalls.

Shaking things up

Dr. Olayinka emphasized training quality and the use of feedback to continuously improve the training experience for health workers. She led the development of numerous training guides and materials for polio eradication and developed the country’s first Basic Guide for Routine Immunization Service Providers. She also worked closely with WHO and EU colleagues to develop the first measles campaign field training materials in Nigeria.

Knowing that training of health workers must be continuous, she introduced mentoring as an important post-training approach in Nigeria’s immunization program.

“We needed to move people towards a more interactive approach,” said Dr. Olayinka. “These approaches transfer knowledge while maintaining dignity and recognize that people in the global South have something valuable to contribute.”

Dr Olayinka has witnessed how the polio eradication programme empowers women. ©Folake Olayinka

Recalling her experience training different types of health workers and trying to promote adult learning methods, she said, “I once walked into a room of senior health commissioners from all over the country. The room was filled with the usual PowerPoints, and people were not engaged – even sleeping.”

“When I went to the front of the room for my session, I introduced myself using my first name and explained the more interactive approach that I was proposing for the training. At first people were silent, but as the training went on, they really came alive. They were engaged and now identifying the real issues and generating the types of ideas that could truly change policy and improve services – you could see their passion coming through. I felt the ship took a turn.”

Dr. Olayinka also tackled training needs at the community-level and strongly promoted the use of local languages in the training of frontline health workers, particularly social mobilizers for polio eradication.

“At local level in northern Nigeria, most people spoke Hausa; however, training materials were largely in English at the time, and many of the women who were able to enter the homes to provide polio vaccinations did not understand English.”

“The polio programme was at a crisis point and was also facing a lot of refusals. As people in the region were not receiving other basic health services, they began not to trust polio vaccination efforts as it was one of the only services they were receiving.”

A pivot was needed, with a closer examination of what was working – and what was not – for all aspects of the eradication effort.

“These women were looking for the basics: how do I answer questions from caregivers, how do I provide polio drops, how do I enter my data?” remembers Dr. Olayinka “With this insight, I developed a flip chart using pictures – I even included a photo of my own son receiving the oral polio drops. We also used the local languages, role play, peer to peer methods, and songs as part of the training methodology.”

In the area of routine immunization, Dr. Olayinka worked with her team and other partners to introduce a stronger supervision system. The system included a checklist with clear standards for supervision of routine immunization, as well as a checklist on training quality as part of the pre-campaign preparedness. This helped National Primary Health Care Development Agency staff to provide ongoing support and mentorship for health workers. Many of these approaches and materials are still being used today and are updated periodically.

At the heart of the response, you will find a woman

Dr. Olayinka worked in a particularly challenging environment in northern Nigeria. “There are gender dimensions tightly linked with socio-cultural and deep-seeded religious beliefs in the northern state”, she recalled.

Oftentimes mothers had to seek permission from their husbands before they could allow the children to be vaccinated or access health services. “Even when they understood the value, women did not have decision-making power.”

The polio programme was able to reach women in new ways. Men originally started out as polio workers, but it quickly became apparent they were missing children under five because they were not allowed into homes due to cultural norms. The solution: hire women to go door-to-door and reach populations being missed.

“The polio programme brought women out into the workforce in an unprecedented way, says Dr. Olayinka. “Women were powerful mobilizers, particularly older, respected women and could enter any home. The polio programme was one of the first programmes bringing the women out, training them how to speak to other women and community members, which gave them a standing in the community. They also received some stipends which empowered them a bit financially.”

Many of these women later transitioned to supporting broader immunization and other health efforts in their communities, leading to higher child survival rates and less disease in communities.

“This is part of my passion when I talk about integration – these women in the communities, after getting a start from the polio programme, can be trained to talk about routine immunization, use of long-lasting insecticidal nets to prevent malaria, breastfeeding, WASH etc.”

“As a result of the polio programme they have social capital that can be expanded to improve health outcomes in their communities.”

To women leaders of the future

Dr. Olayinka remains committed to elevating the contributions of frontline health workers operating in challenging situations across the world.

When asked what advice she would give to women beginning their careers in public health, Dr. Olayinka said, “Be persistent and do not give up on your dreams. Even where you face discrimination because you are a woman, be focused and persist. Ensure that you are constantly building your capacity and equip yourself.”

“Women at all levels can make a difference, so take the leap—there are no limits to what you can achieve.”

In November:

  • 3 cases of Wild Polio Virus (WPV1) were confirmed
  • 54 cross-border teams and 288 permanent transit teams (PTTs) were operational across Afghanistan in November 2020.
    These teams vaccinated 79,489 and 538,674 children, respectively.

In November:

  • 1 case of Wild Polio Virus (WPV1) was confirmed
  • 39,406,287 children were vaccinated during the November NIDs
  • One million children were vaccinated at 121 critical PTPs
148th session of the WHO Executive Board in Geneva, Switzerland. ©WHO / Christopher Black

Meeting virtually at this week’s WHO Executive Board (EB), global health leaders and ministers of health urged for concerted and emergency efforts to finally rid the world of polio, noting a global and collective responsibility to finish the disease once and for all. Delegates also reiterated their support for the sustainable transitioning of polio assets, recognizing that successful polio transition and polio eradication are twin goals.

Noting that endemic wild poliovirus is now restricted to just two countries – the lowest number in history – with the African region being certified as wild polio-free in August 2020, delegates urged intensified efforts to wipe out the remaining chains of transmission of this strain and prevent global resurgence. The representatives of both Pakistan and Afghanistan demonstrated strong commitments to this goal and urged collective responsibility to achieve success. Delegates also expressed strong appreciation for the establishment of the Eastern Mediterranean Ministerial Regional Subcommittee on Polio Eradication and Outbreaks, by WHO Regional Director Dr Ahmed Al-Mandhari, which focuses on critical barriers to overcome to achieve zero poliovirus.

The EB urged all stakeholders to follow WHO and UNICEF’s joint emergency call to action, launched 6 November 2020, including by prioritising polio in national budgets as they rebuild their immunization programmes in the wake of COVID-19, and urgently mobilising additional resources for polio emergency outbreak response. To address the increasing global health emergency associated with circulating vaccine-derived poliovirus (cVDPV) outbreaks, delegates expressed appreciation of new strategic approaches, including the roll-out of novel oral polio vaccine type 2 (nOPV2), a next-generation OPV aimed at more effectively and sustainably addressing these outbreaks. This vaccine, which was recently granted a WHO Emergency Use Listing recommendation, is anticipated to be initially rolled-out in the first quarter of 2021. The GPEI is working with countries affected and at high risk of cVDPV2 to prepare for possible use of the vaccine.

Amid the new COVID-19 reality, the EB also expressed deep appreciation for the GPEI’s ongoing support to COVID-19 response. In December 2020, the heads of the GPEI core partners at their final Polio Oversight Board (POB) meeting of the year, confirmed that the polio infrastructure will continue to provide such support, including to the COVID-19 vaccine roll-out.

Member States additionally reiterated their support of polio transition, emphasising the need to ensure sustained, robust public health programming. Several EB members urged for strengthening the links built between the polio, immunization and emergencies programmes during COVID-19 response in the next phase of the pandemic, including for the effective rollout of the COVID-19 vaccine.

Children waiting at a polio vaccination campaign in Al-Mualla district, Yemen. ©WHO/EMRO

Director-General of WHO, Dr Tedros Adhanom Ghebreyesus, commented, “We share the understanding that polio eradication and transition are equally important targets: as we work towards eradication we must think about the future. This is how we will ensure that health systems retain capacity and are strengthened long after polio is ended.”

WHO’s Deputy Director-General, Dr Zsuzsanna Jakab, noted the increasing cross-programmatic integration between polio and other public health programmes, including the introduction of integrated public health teams in countries prioritized for polio transition, bringing together polio, emergencies and immunization expertise. The Regional Director for the African Region, Dr Matshidiso Moeti, emphasised that the work of polio personnel to support the pandemic response, “highlight[s]… the importance of working in interconnected ways going forward.” Dr Al-Mandhari, addressing the delegates, said: “Polio continues to be a public health emergency of international concern. Now is the time to be shoring up the polio programme and mobilizing funding, including domestic funds, so that this remarkable public health and pandemic response mechanism can remain robust and can be integrated into broader public health services across the region. Now is the time for full regional solidarity and mobilization.”

Speaking on behalf of children worldwide, Rotary International – the civil society arm of the GPEI partnership – thanked global health leaders for their continued dedication to polio eradication and public health, sentiments echoed by several other partners, including the United Nations Foundation (UNF). UNF expressed concern about the drop in population immunity, especially for polio and measles, declared support for the joint emergency call to action to prioritize investments for preventing and responding to polio and measles outbreaks, and urged continued focus on strengthening immunization programmes. 

The EB discussion will also help inform the finalization of the new strategic plan. This strengthened strategic plan – being developed in broad consultation with partners, stakeholders and countries – is based on best practices and lessons learned, and focuses on fully implementing approaches proven to work. It is expected to be presented to the World Health Assembly in May.

“If we did not know it before, we certainly know now how quickly infectious diseases can spread across the world and wild polio is one such infectious disease.  Unlike with COVID-19, where many medical and scientific questions remain unanswered, we know precisely what it takes to stop polio,” said Aidan O’Leary, newly-appointed Director of the Global Polio Eradication Initiative at WHO. “We know how polio transmits, who is primarily at risk and we have all the tools and approaches needed to stop it. That is what this strengthened strategic plan is all about – to bring all the solutions together into a single roadmap to achieve success and through focusing on more effective implementation. What discussions at the EB this week clearly displayed is a strong global sense of commitment and solidarity to do just that: better implementation of what we know works.  Together, if we do that, success will follow and we will be able to give the world one less infectious disease to worry about, once and for all.”

Speaking more broadly on global public health issues, the EB welcomed confirmation by the United States of its intention to remain a member of WHO. In a statement by the United States, the country underscored WHO’s critical role in the world’s fight against COVID-19 and countless other threats to global health and health security, confirming it would continue to be a full participant and global leader in confronting such threats and advancing global health and health security.