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.

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:

  • 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

Download

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.

Download

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.

Health worker Saira Faisal vaccinates a child against polio in Saddar town, Karachi, in August 2020. ©UNICEF/Pakistan

With masks on their faces and sanitizers in their pockets, an immunization team makes their way through the narrow lanes of Lahore’s historic old city.

Our children are like flowers and these anti-polio drives help them grow up healthy and strong,” says Zubair, who along with his colleague Afzal is part of Pakistan’s 260,000-strong frontline vaccinator workforce.

It is the second day of the National Immunization Days (NID) campaign, which launched on 21 September, and the third immunization drive after a four-month suspension of door-to door campaigns due to the risks associated with COVID-19.

After polio campaigns were stopped in March 2020, the number of polio cases in Pakistan continued to increase. An initial small-scale round of vaccinations resumed in July, when over 700,000 children were reached. A second round went ahead in August, where 32 million children were vaccinated across the country. In both campaigns, vaccinators took precautions to prevent the spread of COVID-19, including wearing masks and regularly washing hands.

Making their way from the crowded streets of Taxila Gate, the polio team reaches a historic cultural hub of Lahore city called Heera Mandi.

In this neighbourhood, the team knocks on one door after another. “Sister, do you have children under five at home?”, they say.

When the answer is yes, one of the vaccinators stands to the side while Zubair hands them a hand sanitizer. They all stand at a safe distance from each other, to remain compliant with COVID-19 safety measures, and to make sure the dual message of the necessary fight against both polio and COVID-19 reaches home.

Polio Worker Aliza Mukhtiyar Using Hand Sanitizer ©WHO/EMRO

Zubair says that since the resumption of immunization campaigns in Pakistan, parents have been more enthusiastic to ensure their children are vaccinated.

Next door, a Maulana (a religious cleric) answers. When he sees the polio team, he immediately goes back inside. Team members worry that he may reject the vaccine, but soon enough, he returns with his two children.

Did you ever believe that the polio vaccination was a conspiracy?,” the Maulana is asked. In some parts of Pakistan, false rumours about the vaccine have damaged confidence in immunization, with sometimes devastating results for children subsequently infected with polio.

No Sir, only a fool can think like that,” he replies.

Afzal, another member of the immunization team, says that he finds his work fulfilling because it allows him to directly speak to parents about polio and explain that they can give their children a healthy future by vaccinating them.

With a physical disability, Afzal often faces discrimination based on his health condition. He explains that this hasn’t prevent him from pursuing his ambitions.

I never allowed my disability to become an obstacle. I completed my master’s degree while attending regular classes at college, and now I have been working with the polio programme for nine years.”

“If a family is hesitant during a polio campaign, I approach the parents,” he says. I show the parents my polio-affected leg and ask them if they really want their child to have one too. This changes hesitation to acceptance.”

Health workers like Zubair and Azfal are working every day to achieve the dream of ending polio in Pakistan. With their effort and the efforts of thousands like them, the September campaign successfully reached over 39 million children across the country. These promising results, achieved during a pandemic, are a testament to an ongoing commitment to overcome challenges and move Pakistan closer to a polio-free future.

In October:

  • 2 cases of Wild Polio Virus (WPV1) were confirmed
  • Cross-borderteams and permanent transit teams (PTTs) vaccinated 78,286 and 520,208 children respectively

Download

13 Novembre 2020 – Aujourd’hui, le programme de préqualification de l’Organisation mondiale de la Santé (OMS) a émis une recommandation d’autorisation d’utilisation d’urgence au titre du protocole EUL pour un nouveau vaccin antipoliomyélitique oral de type 2 (nVPO2). Le déploiement du vaccin sera ainsi autorisé pour une utilisation initiale limitée dans les pays touchés par des flambées de poliovirus circulant dérivé d’une souche vaccinale de type 2 (PVDVc2).

L’émission de cette recommandation au titre du protocole EUL pour le nVPO2 vient au terme de plusieurs mois d’analyse rigoureuse des données issues d’essais cliniques qui ont démontré l’innocuité du vaccin et une protection contre la poliomyélite comparable à celle fournie par le VPO monovalent de type 2 (VPOm2) actuellement utilisé.

Le nVPO2 est une version modifiée du VPOm2, mis au point depuis près de dix ans grâce à la collaboration d’un vaste réseau d’experts mondiaux.[1] Outre son innocuité et son efficacité, les essais cliniques montrent que ce vaccin est génétiquement plus stable que le VPOm2, ce qui réduit nettement la probabilité qu’il retrouve une forme pouvant entraîner une paralysie dans les milieux présentant un faible niveau d’immunité. Par conséquent, le nVPO2 réduit le risque de voir apparaître de nouvelles flambées de PVDVc2, même si le VPOm2 demeure un vaccin sûr et efficace qui protège contre la poliomyélite et qui a permis d’empêcher des flambées de PVDVc2 par le passé.

Qu’est qu’une autorisation d’utilisation d’urgence ?

La procédure EUL de l’OMS, anciennement connue sous le nom de procédure d’évaluation et d’homologation en situation d’urgence de l’OMS (Emergency Use Listing, EUL), a été créée pour évaluer et répertorier les nouveaux vaccins, traitements et produits diagnostiques qui ne sont pas encore homologués afin qu’ils puissent être utilisés de façon précoce et ciblée en réponse à une urgence de santé publique de portée internationale (USPPI).

 Ce mécanisme a déjà été utilisé avec succès pour accélérer la mise à disposition de produits diagnostiques pour les virus Ebola et Zika et, fin septembre, une autorisation d’utilisation d’urgence au titre du protocole EUL a été émise pour un test de diagnostic rapide de l’antigène de la COVID-19 qui donne des résultats en 30 minutes.

 Pour qu’un produit reçoive une recommandation d’utilisation au titre du protocole EUL, l’OMS et des experts indépendants examinent les données cliniques existantes afin de déterminer son innocuité, sa qualité et son efficacité, et la décision d’émettre une recommandation est fondée sur une évaluation approfondie des avantages et des risques au vu de l’urgence de santé publique.

Pendant toute la durée d’utilisation d’un produit au titre du protocole EUL, on continue à recueillir des données et à les suivre de près afin de déterminer si ce produit peut recevoir une autorisation d’utilisation d’urgence au titre du protocole EUL.

Pourquoi le protocole EUL est-il utilisé pour le nVPO2 ?

Compte tenu des situations d’urgence actuelles concernant le PVDVc2 en Afrique et en Asie et du fait que la poliomyélite est considérée depuis 2014 comme une urgence de santé publique de portée internationale (USPPI), au mois de février, le Conseil exécutif de l’OMS a prié instamment les États Membres d’accélérer les procédures d’autorisation de l’importation et de l’utilisation du nVPO2 au titre du protocole EUL au vu des résultats prometteurs de ce vaccin dans la lutte contre le PVDVc2.

Les flambées de PVDVc2 se produisent lorsque la souche affaiblie du poliovirus contenue dans le vaccin antipoliomyélitique oral (VPO) peut se propager au sein de populations sous-vaccinées pendant une période prolongée et retrouver une forme pouvant entraîner une paralysie. L’année dernière, il y a eu 366 cas de PVDVc2 dans le monde. Au cours des dix premiers mois de 2020, on a recensé 588 cas (données au 28 octobre 2020).

Outre la décision du Conseil exécutif, le Groupe stratégique consultatif d’experts (SAGE) sur la vaccination a approuvé dans son principe un cadre définissant les critères d’une utilisation initiale pour permettre le déploiement rapide et ciblé du nVPO2. À la suite de sa réunion du 5 au 7 octobre, le SAGE a également approuvé, sur le principe, que le nVPO2 devienne le vaccin de choix pour lutter contre les flambées de PVDVc2, une fois que l’examen de la période initiale d’utilisation sera terminé et que toutes les conditions d’utilisation de ce nouveau vaccin seront remplies.

Des études cliniques sur le nVPO2, menées en Belgique et au Panama, ont montré que le vaccin était sûr et efficace pour protéger contre la poliomyélite, et qu’il présentait moins de risque de retrouver une forme pouvant entraîner une paralysie dans des populations sous-vaccinées.

Au cours des six derniers mois, le programme de préqualification de l’OMS a minutieusement analysé les données émanant de ces études afin de déterminer si le nVPO2 répondait aux exigences du protocole EUL. Grâce à la recommandation au titre de ce protocole, le nVPO2 constitue désormais un moyen supplémentaire de la Stratégie de lutte contre le PVDVc2 de l’IMEP.

Quelle est la période d’utilisation initiale du nVPO2 ?

Comme le précise le cadre approuvé par le SAGE, la période d’utilisation initiale durera environ trois mois après la première utilisation du nVPO2 au titre du protocole EUL, et ce vaccin sera déployé de manière mesurée dans la lutte contre les flambées de PVDVc2.

L’IMEP travaille étroitement avec les pays touchés par des flambées de PVDVc2 afin de déterminer où le nVPO2 peut être utilisé pendant la période initiale. Cette décision s’appuiera notamment sur la situation épidémiologique actuelle et sur la capacité du pays à mener la surveillance renforcée requise en termes d’innocuité et d’efficacité du nVPO2 pendant son déploiement.

 Il est important de noter que toute décision d’utiliser le nVPO2 sera prise par le pays et soumise à l’accord des responsables concernés dans le pays et des autorités de réglementation nationales. Le VPOm2 restera disponible pour faire face aux flambées dans les pays qui ne répondent pas aux critères d’une utilisation initiale ou qui décident de ne pas utiliser le nVPO2 initialement.

 L’utilisation initiale du nVPO2 devrait avoir lieu environ cinq à huit semaines après la publication de la recommandation d’utilisation au titre du protocole EUL, en tenant compte des processus réglementaires et des approbations définitifs, de l’achat des vaccins, de l’expédition et de l’état de préparation du pays. L’IMEP continue de travailler en étroite collaboration avec les pays à haut risque, en les aidant à se préparer à utiliser le nVPO2.

Perspectives d’avenir

On continuera à recueillir des données sur le nVPO2 pendant la période d’utilisation initiale, en plus des études en cours et de celles qui seront menées prochainement.

Parallèlement à l’utilisation initiale du nVPO2, l’IMEP poursuivra la mise en œuvre des autres volets de sa stratégie globale de lutte contre les flambées de PVDVc2. Cette stratégie consiste notamment à optimiser la riposte aux flambées en utilisant le VPOm2, à renforcer la vaccination systématique avec le vaccin antipoliomyélitique inactivé dans les zones à haut risque et à veiller à ce que les stocks de VPO soient suffisants pour que chaque enfant puisse en bénéficier.

En savoir plus sur le développement de nVPO2


[1] Le nVPO2 a été mis au point grâce à un partenariat mondial réunissant de multiples agences et experts internes et externes à l’Initiative mondiale pour l’éradication de la poliomyélite (IMEP). Il s’agit notamment de Bio Farma, de l’Université d’Anvers, de la FIDEC (Fighting Infectious Diseases in Emerging Countries), du NIBSC (National Institute for Biological Standards and Control), de l’UCSF (University of California San Francisco), des CDC (Centers for Disease Control and Prevention des États-Unis), de PATH et de la Fondation Bill et Melinda Gates.

Version française

13 November 2020 – Today, the World Health Organization’s (WHO) Prequalification (PQ) program issued an Emergency Use Listing (EUL) recommendation for the type 2 novel oral polio vaccine (nOPV2). This will allow rollout of the vaccine for limited initial use in countries affected by circulating vaccine-derived poliovirus type 2 (cVDPV2) outbreaks.

The PQ program’s issuance of an EUL recommendation for nOPV2 follows months of rigorous analysis of existing data from clinical trials of the vaccine, that have shown it to be safe and provide comparable protection against polio as the currently used type 2 monovalent OPV (mOPV2).

nOPV2 is a modified version of mOPV2 and has been in development for close to a decade thanks to the collaboration of an extensive network of global experts.[1] In addition to nOPV2’s safety and efficacy, clinical trials show the vaccine to be more genetically stable than mOPV2, making it significantly less likely to revert into a form which can cause paralysis in low immunity settings. This means a reduced risk of seeding new cVDPV2 outbreaks compared to mOPV2, which remains a safe and effective vaccine that protects against polio and has successfully stopped cVDPV2 outbreaks in the past.

What is an Emergency Use Listing?

The WHO’s EUL procedure, previously known as the Emergency Use Assessment and Listing (EUAL) procedure, was created to assess and list new and yet-to-be licensed vaccines, therapeutics and diagnostics to enable their early, targeted use in response to a Public Health Emergency of International Concern (PHEIC).

This mechanism has previously been used to successfully accelerate the availability of diagnostic products for Ebola and Zika virus, and in late September, EUL was issued for an antigen rapid diagnostic test for COVID-19 that provides results within 30 minutes.

For a product to receive an EUL recommendation, existing clinical data is scrutinized by WHO and independent experts to determine its safety, quality and efficacy, and a decision to list is based on a thorough benefit-risk assessment considering the public health emergency.

Throughout a product’s use under EUL, data continues to be collected and closely monitored to help inform decisions about whether the emergency listing can be maintained.

Why is EUL being used for nOPV2?

In light of ongoing cVDPV2 emergencies across countries in Africa and Asia, coupled with polio’s status as a Public Health Emergency of International Concern (PHEIC) since 2014, the WHO Executive Board urged Member States in February to expedite the processes for authorizing the importation and use of nOPV2 under the EUL given data showing the vaccine’s promise against cVDPV2s.

cVDPV2 outbreaks occur when the weakened poliovirus strain contained in the oral polio vaccine (OPV) is able to spread among under-immunized populations for a prolonged period and reverts to a form that can cause paralysis. Last year, there were 366 cases of cVDPV2 globally, while in the first 10 months of 2020 alone there have been 588 cases (data as of 28 October 2020).

In addition to the Executive Board decision, the Strategic Advisory Group of Experts (SAGE) on Immunization endorsed in principle an initial use criteria framework to support early, targeted nOPV2 rollout. Following its 5-7 October meeting, SAGE also endorsed, in principle, that nOPV2 become the vaccine of choice in response to cVDPV2 outbreaks after review of the initial use period is completed and all requirements for nOPV2’s use are met.

Clinical studies on nOPV2, conducted in Belgium and Panama, have shown the vaccine to be safe and efficacious in protecting against polio, while carrying less risk of reverting into a form that can cause paralysis in under-immunized populations.

Data from these studies has been subject to WHO PQ program’s rigorous analysis for the past six months to determine if nOPV2 meets requirements for EUL. The EUL recommendation means nOPV2 is now an additional tool in the GPEI’s Strategy for Control of cVDPV2.

What is the initial use period for nOPV2?

The initial use period, as detailed in the SAGE-endorsed framework, will last for approximately three months following the first use of nOPV2 under EUL and will see nOPV2 deployed in a measured way to tackle ongoing outbreaks of cVDPV2.

The GPEI is working closely with countries affected by cVDPV2 outbreaks to determine where nOPV2 can be used during the initial period. Factors that will inform this decision include the current epidemiology and the country’s ability to conduct the required enhanced monitoring of nOPV2’s safety and effectiveness during rollout.

Importantly, any decision to use nOPV2 will be country-led and subject to agreement from relevant in-country officials and national regulatory authorities. mOPV2 will remain available for outbreak response in countries that do not meet initial use criteria or choose not to use nOPV2 initially.

It is anticipated that the initial use of nOPV2 will take place approximately five to eight weeks after the EUL recommendation issues, factoring in final regulatory processes and approvals, vaccine procurement, shipping and country readiness. GPEI continues to work closely with high-risk countries, supporting with preparations to use nOPV2.

Looking ahead

Data on nOPV2 will continue to be collected during the initial use period, in addition to further nOPV2 studies that are underway and will be conducted in the near future.

Alongside nOPV2’s initial use, the GPEI will continue to implement the other strands of its comprehensive strategy to control cVDPV2 outbreaks. This includes optimizing outbreak response using mOPV2, strengthening routine immunization with inactivated polio vaccine in high-risk areas, and ensuring adequate supplies of OPV are available to reach every child.

Read more on nOPV2 development


[1] A global partnership across multiple agencies and experts from within and outside of GPEI have supported nOPV2’s development. This includes Bio Farma, University of Antwerp, Fighting Infectious Diseases in Emerging Countries (FIDEC), National Institute for Biological Standards and Control (NIBSC), University of California San Francisco (UCSF), US Centers for Disease Control and Prevention (CDC), PATH, the Bill & Melinda Gates Foundation, and several others.

 

Michel Zaffran

For almost five years I have had the immense privilege of heading Polio Eradication at WHO, representing the agency as we lead the Global Polio Eradication Initiative and work towards our goal of a polio-free world. Since 1988, we have reduced incidence of polio by 99.9% and more than 18 million people are walking today who would otherwise have been paralyzed. We are so close to achieving global eradication of this disease – only the second human disease ever to be eradicated, after smallpox. Now, as we progress our strategic plan to end polio by 2023, it is time to pass on the baton.

Over the last few years, we have endured daunting challenges: Fighting outbreaks in three WHO regions, battling against vaccine misinformation and facing setbacks to the eradication of polio in Afghanistan and Pakistan. I have also witnessed incredible progress made: Eradicating wild polio type 3 worldwide, succeeding against the virus in war-torn Syria, overcoming wild polio in Nigeria, and developing a new, more stable oral vaccine. We have also been joined in our efforts by Gavi, the Vaccine Alliance, who further strengthen our partnership.

Our impact is magnified as polio teams lead COVID-19 response operations in vulnerable contexts across the globe.

What kind of person can carry us over the finishing line to a polio-free world? From my experience I believe certain qualities are a must: a strategic thinker and a diplomat; a background in epidemiology; an engaged manager; someone with diverse field experience. They must navigate effectively between all three levels of WHO, and effectively bring the Global Polio Eradication Initiative partners together to achieve a polio-free world. They must be excited by the opportunity to engage with diverse actors – from technical colleagues and civil society representatives, to the vaccine industry. Science has paved the way to polio eradication, but it is people – and people skills – that will take us to the destination.

My successor will be joining the programme at a truly challenging time for polio eradication and for public health. To me, this also presents a unique and motivating opportunity.

In a post-COVID-19 world, our new director will lead on efforts to further define and adapt our approach to respond to the immense challenges raised by the pandemic.

Polio eradication is an exhilarating project to lead in part because the programme has the capacity to both end polio and make a significant contribution to broader global health goals. Already we are supporting countries to make life-saving gains: Increasing access to healthcare in the most remote places, strengthening routine immunization systems, implementing our gender strategy and ensuring strong disease surveillance for polio, COVID-19 and other diseases.

This job offers the opportunity to steer and influence how we integrate with other health programmes over the coming years and secure lasting assets for communities long after poliovirus is defeated.

Overcoming the last and hardest mile will require commitment and creativity. The role calls for out-of-the-box thinking and action in numerous programmatic areas: on financing, outbreak response, and ensuring adequate vaccine coverage for the hardest-to-reach children in Afghanistan and Pakistan, the only two countries that remain wild polio-endemic. My successor must simultaneously look beyond eradication of the last virus in the wild, towards safely containing all polioviruses that are kept for study post-eradication.

My experiences over the last few years have confirmed to me that this is one of the most exciting and rewarding challenges in global health, to help rid the world of a human disease for only the second time.

If you are a global health leader with the requisite passion, experience and vision for a world where no child suffers polio paralysis ever again, I will be honoured to pass on the baton to you.

More information

Deadline: 15 July 2020

Nurse Madelein Semo vaccinates a young baby with inactivated polio vaccine (IPV) at the Ngbaka health centre in Kinshasa, Democratic Republic of the Congo, on April 29, 2015. Gavi’s support for IPV represents the insurance policy for the success of the Polio Endgame Strategy. ©GAVI/2015/Phil Moore

On 4 June 2020, the UK Government hosted Gavi’s third donor pledging conference, the Global Vaccine Summit, to mobilize at least US$ 7.4 billion to protect the next generation with vaccines, reduce disease inequality and create a healthier, safer and more prosperous world. Responding to this unique call for global solidarity, leaders from donor countries and the private sector made unprecedented commitments of US$ 8.8 billion in order to save up to 8 million lives.

Since 2019, the Global Polio Eradication Initiative (GPEI) has strengthened its collaboration with Gavi, inviting Gavi to become the sixth core partner of the GPEI. While the GPEI will continue its focus on interrupting virus transmission and eradicating polio through immunization campaigns using the oral polio vaccine (OPV), Gavi’s support for the inactivated polio vaccine (IPV) at an estimated cost of US$ 800 million during its 2021-25 strategic period represents the insurance policy for the success of the Polio Endgame Strategy.

Thanks to the remarkable mobilization and solidarity of leaders worldwide, Gavi will be able to maintain immunization in developing countries, mitigating the impact of the COVID-19 pandemic. Gavi will also be able to sustain health systems so that countries are ready to rapidly introduce COVID-19 vaccines. And by 2025 Gavi will have immunized more than 1.1 billion children, saving 22 million lives. Ngozi Okonjo-Iweala, Chair of the Gavi Board, highlighted why this is so important, saying, “Vaccinations should be recognized as a global public good. With your support and commitment, we can generate US$ 70 to US$ 80 billion additional economic benefits.”

Henrietta Fore, Executive Director of UNICEF, added, “We have effective vaccines against measles, polio and cholera. While circumstances may require us to temporarily pause some immunization efforts, these immunizations must restart as soon as possible, or we risk exchanging one deadly outbreak for another.” UN Secretary-General Antonio Guterres urged partners to “find safe ways to continue to deliver vaccinations during COVID-19.” GPEI, Gavi, WHO and UNICEF have issued guidance for countries to encourage resuming immunization activities once it is safe to do so, in recognition of the fact that numerous countries are facing COVID-19 and multiple other disease outbreaks.

During the Summit, top Gavi donors reaffirmed their leadership, including Norway, the UK and the USA, as well as the Bill & Melinda Gates Foundation. Prime Minister Boris Johnson pledged £1.65 billion, recommitting the UK as Gavi’s leading donor while the Gates Foundation committed US$ 1.6 billion. More than 60 leaders from all regions of the world in the Asia-Pacific, Middle East, Africa, Europe and the Americas pledged support to Gavi, the Vaccine Alliance both for its upcoming strategic period as well as for COVID-19 response.

The COVID-19 pandemic reminds us of the power of vaccines. WHO Director-General Tedros Adhanom noted, “COVID-19 is a devastating reminder that life is fragile, and that in our global village our individual health depends on our collective health. … Now is the moment for the world to come together in solidarity to realise the power of vaccines for everyone.” Responding to this challenge, Gavi has launched the Gavi Advance Market Commitment for COVID-19 (Gavi Covax AMC), which aims to raise additional funding in late June under the leadership of the European Union. Bill Gates,  noted, “We would have to create Gavi if it did not exist today to solve the COVID-19 crisis.”

Michel Zaffran, director of the WHO polio eradication programme, said, “Congratulations to the Gavi family for this exemplary mobilization and demonstration of global solidarity. We are immensely grateful to Gavi and its donors for their precious partnership and generous support for the inactivated polio vaccine (IPV). The COVID-19 pandemic is a terrible tragedy, which brings us together more than ever and requires to think collectively how best to address the needs of the communities.”

Rotary, one of the six GPEI partners, echoed statements from other agencies. “Rotary and its members applaud the commitment of the donors and governments who have pledged their support to ensuring that vulnerable communities can receive lifesaving vaccinations,” said Michael K. McGovern, Polio Oversight Board and Chair of Rotary’s International PolioPlus Committee. “Continued investment from the global community in programmes such as the Global Polio Eradication Initiative is crucial to not only achieving the eradication of polio, but ensuring stronger health systems worldwide. This firm commitment truly embodies the “Plus” in PolioPlus.”

While the Global Vaccine Summit secured the IPV requirements for polio eradication efforts through 2025, further financial commitment is needed for the GPEI to restart the immunizations campaigns that have been paused during the COVID-19 pandemic. More intensive and integrated immunization activities are needed to finish the job and to strengthen the capacities of the governments, health workers and networks, so that the investment in polio eradication can serve as a foundation for future pandemic response. While celebrating the success of the Global Vaccine Summit, GPEI calls for reiterated donor support to eradicate polio once and for all.

Related resources

A polio worker administering the life-saving polio drops to children in Pakistan © WHO/EMRO

In the midst of the COVID-19 pandemic, it is more critical than ever to recognize the power and importance of vaccines, which save millions of lives each year. Canada, the first government to contribute to the global effort to eradicate polio in 1986, has announced new investments to support immunization. Alongside renewed funding for Gavi, the Vaccine Alliance, the Honourable Karina Gould, Canada’s Minister of International Development, committed C$ 47.5 million annually over four years to support the Global Polio Eradication Initiative’s Endgame Strategy.

Due to widespread polio vaccination efforts over the past 30 years, more than 18 million people are walking today who would otherwise have been paralyzed, and cases have dropped by 99.9% thanks to the tireless efforts of health workers, local governments and global partners. The GPEI is proud to count on generous donors, including Canada, who have helped make this progress possible. This new investment will help the programme ensure gains made to date are not lost, resume activities as soon as it is feasible, implement strategies to overcome the remaining barriers to eradication, and further the dream of a polio-free world.

Minister Gould stated: “As a global community, we must work to ensure that those most vulnerable, including women and children, have access to vaccinations to keep them healthy wherever they live. COVID-19 has demonstrated that viruses do not know borders. Our health here in Canada depends on the health of everyone, everywhere. Together, we must build a more resilient planet.” The Minister added “The world has never been closer to eradicating polio, but the job is not done. With continued transmission in Afghanistan and Pakistan, we cannot afford to be complacent.”

Frontline polio workers in countries around the world are currently supporting the COVID-19 response, using networks established by the GPEI to focus on case detection, tracing, testing and data management. The G7 and the G20, including the Canadian Government, have recognized the important role GPEI assets play in strengthening health systems and advancing global health security, especially among the most vulnerable populations of the world.

In line with its feminist international assistance policy, Canada has encouraged the GPEI to build on the important role played by women in the programme, from the front lines to programme management and political leadership.

Akhil Iyer, Director of the Polio Eradication Programme at UNICEF said, “The new funding from the Canadian government is a testament to the major role played by the Canadian people in the historical fight against polio, and I am proud to be part of this endeavour as a Canadian citizen myself. Back in the 1950’s in Canada, poliovirus outbreaks could have paralysed or killed so many more children, and could have plagued the economy and pushed millions in vicious circles of poverty and ill health. But thanks to the scientific breakthrough of Dr. Leone Farrell who made mass production of polio vaccines possible, strong leadership and a learning health system, Canada was able to overcome the polio outbreaks and thrive during the following decades. It is more inspiring than ever, as we strive together to end polio from the world for good.”

Rotary clubs throughout Canada welcomed the new pledge as a continuation of the country’s leadership and partnership to end polio. Canada has worked closely with Rotary clubs in Canada since 1986 when Canada became a donor to GPEI. To date, Canadian Rotarians have raised and contributed more than US$ 41.3 million to eradication efforts.

Michel Zaffran, Director of the Polio Eradication Programme at the World Health Organization said, “I would like to express the profound gratitude of the GPEI partners to the Government and to the citizens of Canada for their tremendous support and engagement to end polio globally. The pandemic we are facing today is a stark reminder of the critical need for solidarity at all levels, international cooperation and of the power of vaccines and immunization. Canada is walking the talk: it is demonstrating once more its exemplary commitment to ensuring access to essential vaccinations, leading efforts to advance gender equality and reducing the burden of infectious diseases.”

Related resources

Global health leaders at an Executive Board Meeting. © WHO
Global health leaders at an Executive Board Meeting. © WHO

7 February 2020 – Meeting in Geneva, Switzerland, Member States of the Executive Board expressed overwhelming support to the global effort to eradicate polio, in the face of an alarming polio epidemiology which emerged in 2019.

Last year saw an upsurge of wild poliovirus cases in Pakistan and Afghanistan, and an unexpectedly large number of circulating vaccine-derived poliovirus outbreaks. To address the situation requires new energy, and Member States strongly asserted their support to urgently achieve a world free of all strains of poliovirus.

Addressing the delegations, WHO Director of the Global Polio Eradication Initiative Michel Zaffran noted the strong response of Member States to 2019 setbacks: “Witnessing the efforts of colleagues, and the commitment of national governments, I feel personally confident and optimistic that we have begun to turn things around to ensure success. I see new commitments at country level. In Pakistan, a re-launch of the effort began midway through 2019. The programme undertook an in-depth analysis of the major area-specific challenges and their root causes, which they have now started to address.”

Eradicating polio in the remaining global wild poliovirus transmission block in Afghanistan and Pakistan is critical, as failure could result in global resurgence of the disease. Modelling indicates that within ten years, 200,000 cases would be reported worldwide, every single year. The risk of global spread of communicable disease has this year been underlined by the novel coronavirus (2019-nCoV) situation.

Member States also almost unanimously offered their support and commitment to closing outbreaks of vaccine-derived viruses (cVDPVs), endorsing new and concerted efforts. With Africa on the verge of being certified free of wild poliovirus, WHO Regional Director for Africa Dr Matshidiso Rebecca Moeti emphasised that the continent will continue to fully commit to eradication efforts until the cVDPV2 emergency is overcome. “New approaches and rapid response teams across the continent are intensifying their efforts in ensuring every child is reached during outbreak response, and that new outbreaks are rapidly detected and responded to.”

To this effect, the Executive Board endorsed in a Decision a new cVDPV2 outbreak response strategy, including accelerated roll-out of novel oral polio vaccine type 2 (nOPV2) to more effectively address the cVDPV2 health emergency currently affecting parts of Africa, the Middle East and the Southeast Asia region.  Novel OPV2 – a brand new tool to address outbreaks – could be available to address this health emergency as early as mid-2020 under WHO’s Emergency Use Listing procedure.

The new vaccine, however, is only half the battle, cautioned Zaffran, stressing that resources and operational improvements are needed to ensure the vaccine reaches every last child. “We also need to implement stronger outbreak response and ensure more comprehensive surveillance, both things that cost money. With thanks to the generosity of the international development community, we have mobilized pledges of US$2.6 billion made at the Last Mile Forum in Abu Dhabi just two months ago. But this will not be enough to eradicate polio and tackle these increasing number of outbreaks. We are therefore calling on member states to mobilize domestic resources to respond to outbreaks, where possible.”

Zaffran continued: “On the horizon I witness a new epidemiological situation slowly beginning to emerge. I see a new, re-launched programme which has the building blocks in place to lead us to success.  Let us not be under illusions however. This will not happen overnight and this will not be easy. The nature of the virus is that every operational improvement will take several months or longer to be reflected in epidemiology. This is the way polio eradication works: there is always a time-lag. So for now, we need to measure our progress in programmatic and operational success. We must continue our new commitments, action our new strategies, introduce new tools, monitor results and maintain our drive. Significant impact on epidemiology will subsequently follow.”

“We have a lot to do,” Zaffran concluded. “But the programme is starting 2020 on a very strong footing.  I am convinced 2020 will go down in history as the year which turned the programme around, and back onto the path towards lasting success.”

Concluding the polio deliberations and speaking on behalf of 1.2 million Rotarians worldwide, Judith Diment, Chair of the Rotary Polio Advocacy Task Force, stated: “Rotary remains fully committed to the pursuit of a polio free world, as evidenced by our extended commitment to raise 50 million dollars annually through 2023. We urge all countries to devote the national financial and human resources needed to sustain high levels of population immunity through routine immunization, mitigate the risk of polio outbreaks and avoid significant unnecessary human and financial cost. The window of opportunity to achieve a polio-free world will not remain open forever. The time for urgent action is now.”

 

Polio workers hold up a banner during a 5-day campaign to vaccinate 2.6 million children in Kenya. ©WHO/Kenya
Polio workers hold up a banner during a 5-day campaign to vaccinate 2.6 million children in Kenya in July 2019. ©WHO/Kenya

Brazzaville, 19 December 2019 – Kenya, Mozambique and Niger have curbed polio outbreaks that erupted in different episodes over the past 24 months, World Health Organization (WHO) announced.

Transmission of vaccine-derived poliovirus was detected in the three countries in 2018, affecting 12 children. No other cases have since been detected.

“Ending outbreaks in the three countries is proof that the implementation of response activities and ensuring that three rounds of high-quality immunization campaigns are conducted can stop the remaining outbreaks in the region,” said Dr Modjirom Ndoutabe, Coordinator of the WHO-led polio outbreaks Rapid Response Team for the African Region.

“We are strongly encouraged by this achievement and determined in our efforts to see polio eradicated from the continent. It is a demonstration of the commitment by Governments, WHO and our partners to ensure that future generations live free of this debilitating virus,” added Dr Ndoutabe.

Vaccine-derived polioviruses are rare, but these viruses affect unimmunized and under-immunized populations living in areas with inadequate sanitation and low levels of polio immunization. When children are immunized with the oral polio vaccine, the attenuated vaccine virus replicates in their intestines for a short time to build up the needed immunity and is then excreted in the faeces into the environment where it can mutate. If polio immunization coverage remains low in a community and sanitation remains inadequate, the mutated viruses will be transmitted to susceptible populations, leading to emergence of vaccine-derived polioviruses.

No wild poliovirus has been detected anywhere in Africa since 2016. This stands in stark contrast to 1996, a year when wild poliovirus paralysed more than 75,000 children across every country on the continent. The WHO African Region however, is currently facing outbreaks of a rare poliovirus strain known as circulating vaccine derived poliovirus.

The work of the Rapid Response team starts once the lab confirms that a sample collected from either the environment or a paralysed child is caused by a poliovirus. Every minute that passes from then means that the virus is circulating and risks infecting more children that is why the Rapid Response Team deploys with 72 hours. The team supports local health authorities in the affected country in preparing the risk assessment and outbreak response plan. Then assist with launching the emergency response vaccination campaign, called round zero, within 14 days. A second team then takes over after the first eight weeks and continues the outbreak response activities including ensuring that three more rounds of high-quality vaccination campaigns are conducted.

To end outbreak activities in an affected country national and regional disease surveillance and laboratory teams need to confirm that no polio transmission is detected in samples collected from paralysed children, children in contact, and the environment have been negative for at least nine months. Response to the polio outbreak requires a strong multisector collaboration. In these efforts, WHO with other Global Polio Eradication Initiative spearheading partners: UNICEF, Rotary International, the US Centers for Diseases Control (CDC), the Bill and Melinda Gates Foundation (BMGF) and other stakeholders have been supporting the Government of Angola in implementing measures to end the transmission of the poliovirus.

Countries still experiencing outbreaks of vaccine-derived poliovirus in Africa are: Angola, Benin, Cameroon, Central African Republic, Chad, Côte d’Ivoire, Democratic Republic of the Congo, Ethiopia, Ghana, Nigeria, Togo and Zambia. The risk factors for these outbreaks include weak routine vaccination coverage, vaccine refusal, difficult access to some locations and low-quality vaccination campaigns, which have made immunization of all children difficult.

Countries of the region experiencing outbreaks are continuing to implement outbreak response, following internationally-agreed guidelines and strengthening surveillance activities to rapidly detect any further cases.  To successfully implement the outbreak response required, the engagement of government authorities at all levels, civil society and the general population, is crucial to ensure that all children under the age of five are vaccinated against polio.

Related resources