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.

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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.”

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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.

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Three-year-old Madsa is carried by her sister after receiving a polio vaccine during a door-to-door campaign in Maroua, Cameroon. ©Gates Archive/Dominique Catton
Three-year-old Madsa is carried by her sister after receiving a polio vaccine during a door-to-door campaign in Maroua, Cameroon. ©Gates Archive/Dominique Catton

ABU DHABI, 19 November 2019 – Today, global leaders convened at the Reaching the Last Mile (RLM) Forum in Abu Dhabi to affirm their commitment to eradicate polio and pledge US$2.6 billion as part of the first phase of the funding needed to implement the Global Polio Eradication Initiative’s Polio Endgame Strategy 2019-2023.

This pledging event comes on the heels of a major announcement last month that the world has eradicated two of the three wild poliovirus strains, leaving only wild poliovirus type 1 (WPV1) still in circulation. Additionally, Nigeria – the last country in Africa to have cases of wild polio – has not seen wild polio since 2016 and the entire WHO African region could be certified wild polio-free in 2020. Thanks to the dedicated efforts of health workers, governments, donors and partners, wild polio only circulates in two countries: Pakistan and Afghanistan.

“From supporting one of the world’s largest health workforces, to reaching every last child with vaccines, the Global Polio Eradication Initiative is not only moving us closer to a polio-free world, it’s also building essential health infrastructure to address a range of other health needs,” said Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization and Chair of the Polio Oversight Board. “We are grateful for the generous pledges made today and thank governments, donors and partners for standing with us. In particular, I would like to thank His Highness Sheikh Mohamed bin Zayed Al Nahyan, Crown Prince of Abu Dhabi for hosting the GPEI pledging moment and for his long-term support for polio eradication.”

The commitments announced today come at a critical time for the polio eradication effort. Barriers to reaching every child – including inconsistent campaign quality, insecurity, conflict, massive mobile populations, and, in some instances, parental refusal to the vaccine – have led to ongoing transmission of the wild poliovirus in Pakistan and Afghanistan. Further, low immunity to the virus in parts of Africa and Asia where not all children are vaccinated has sparked outbreaks of a rare form of the virus. To surmount these obstacles and protect 450 million children from polio every year, governments and donors announced significant new financial commitments toward the $3.27 billion needed to support the Polio Endgame Strategy.

Pledges are from a diverse array of donors, including: US$160 million from the host of the pledging moment His Highness Sheikh Mohamed bin Zayed Al Nahyan, Crown Prince of Abu Dhabi; countries, including US$215.92 million from the United States, US$160 million from the Islamic Republic of Pakistan, US$105.05 million from Germany, US$84.17 million from the Federal Government of Nigeria, US$10.83 million from Norway, US$10.29 million from Australia, US$7.4 million from Japan, US$2.22 million from Luxembourg, US$1.34 million from New Zealand, US$116,000 from Spain, and US$10,000 from Liechtenstein; GPEI partners, including US$1.08 billion from the Bill & Melinda Gates Foundation and US$150 million from Rotary International; philanthropic organizations, including US$50 million from Bloomberg Philanthropies, US$25 million from Dalio Philanthropies, US$15 million from the Tahir Foundation, US$6.4 million from the United Nations Foundation, US$2 million from Alwaleed Philanthropies, US$1 million from the Charina Endowment Fund, and US$1 million from Ningxia Yanbao Charity Foundation; and the private sector, including US$1 million from Ahmed Al Abdulla Group, US$1 million from Al Ansari Exchange, and US$340,000 from Kasta Technologies. Earlier this month, the United Kingdom announced it would contribute up to US$514.8 million to the GPEI.

“We are proud to host the GPEI pledging moment in Abu Dhabi and thank all the attendees for their continued commitment to the eradication of polio,” said Her Excellency Reem Al Hashimy, UAE Cabinet Member and Minister of State for International Cooperation. “Since launching in 2014, the Emirates Polio Campaign has delivered more than 430 million polio vaccines in some of the most remote areas of Pakistan.  We remain firm in our mission to reach every last child and believe together we can consign polio to the pages of history.”

In addition to overcoming barriers to reach every child, this funding will ensure the resources and infrastructure built by the GPEI can support other health needs today and in the future. Polio workers deliver Vitamin A supplements, provide other vaccines like those for measles and yellow fever, counsel new mothers on breastfeeding, and strengthen disease surveillance systems to anticipate and respond to outbreaks. As part of its commitment to advance gender equality and women’s empowerment, the GPEI is also working to ensure equal participation of women at all levels of the programme.

The future of polio eradication hinges on support and engagement at all levels of the programme – from individuals to communities to local and national governments to donors. If the strategies needed to reach and vaccinate children are fully implemented and funded, we are confident that we can deliver a world where no child lives in fear of polio.

Pledge values are expressed in US dollars. View the full list of donors and pledge amounts.

Media contacts:

Oliver Rosenbauer

Communications Officer, World Health Organization

Email: rosenbauero@who.int

Tel: +41 79 500 6536

John Butler

Vice President, Global Health Strategies

Email: jbutler@globalhealthstrategies.com

Tel: +44 7502 203498

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Seven-month-old Abdihakim Osman receives double doses of the oral polio vaccine during a national immunization campaign in Hargeisa, Somaliland. G20 members are some of the most committed supporters of polio eradication efforts. ©WHO/Ilyas Ahmed
Seven-month-old Abdihakim Osman receives double doses of the oral polio vaccine during a national immunization campaign in Hargeisa, Somaliland. G20 members are some of the most committed supporters of polio eradication efforts. ©WHO/Ilyas Ahmed

G20 Health Ministers met in Okayama, Japan, on 19 and 20 October 2019 to address major global health issues in order to pave the way towards a more inclusive and sustainable world, as envisioned in the 2030 Agenda for Sustainable Development.

Ministers put a strong emphasis on ending polio in the resulting declaration, reaffirming their “commitment to eradicate polio”, and recognizing the remaining challenges.

Ministers welcomed next month’s pledging event. With the support of G20 members and other important global donors, the Global Polio Eradication Initiative aims to successfully raise funds to overcome the remaining challenges that face the world as we work to end polio. The pledging event will be generously hosted by the UAE and His Highness Sheikh Mohamed bin Zayed Al Nahyan, Crown Prince of the Emirate of Abu Dhabi, as part of the Reaching the Last Mile Forum on 19 November 2019, and intends to secure the financial commitments needed for the programme to finish the job.

Ministers noted, “We are concerned with the rising number of vaccine-derived polio outbreaks. We call for a strong cross-border cooperation and strict implementation of vaccine requirements for travelers as specified in the International Health Regulations (IHR, 2005).”

The polio programme is currently responding to vaccine-derived poliovirus outbreaks in 18 countries. The encouragements of the G20 Health Ministers regarding the pledging event, IHR implementation and cross-border collaboration are welcomed as part of measures to ensure high quality comprehensive outbreak response and the ability of the programme to eradicate the virus.

In addition, Ministers expressed support for “the efforts of the Global Polio Eradication Initiative (GPEI), Gavi, the Vaccine Alliance (Gavi), WHO, UNICEF, and other stakeholders in strengthening routine and supplemental immunization,” and highlighted the “leadership role of WHO”. This year, Gavi has joined the Polio Oversight Board, becoming the sixth partner of the initiative. Ministers referred to the importance of “the transition of relevant polio assets” to other health programmes, a process that will be strengthened by Gavi’s partnership.

Polio eradication has an important role to play in the implementation of other global health goals. Considering this broader context, Ministers recognized that “high quality and safe primary health care including access to vaccination is a cornerstone for UHC”. Ministers noted, “We recognize that immunization is one of the most cost-effective health investments with proven strategies that make it accessible to all segments of the population with an emphasis on women and girls, the most hard-to-reach as well as the vulnerable and marginalized populations. We express our concern about vaccine hesitancy as mentioned in the WHO’s Ten threats to global health in 2019.”

Vaccination is the only way to eradicate polio and the GPEI is working tirelessly in some of the most challenging contexts to ensure all children, boys and girls, regardless of where they live, have access to life-saving vaccines.

This important statement from G20 Ministers of Health represents a continuation of the strong historical political support for polio eradication from both the G7 and the G20, at the highest levels.

The statement also follows the reaffirmation of support for polio eradication by G20 health leaders during their June 2019 summit. In this meeting, they discussed major challenges facing the world and once more communicated that “we reaffirm our commitment to eradicate polio”.

In 2020, Saudi Arabia will hold the presidency of the G20 and the US Government will hold the Presidency of the G7.

The Government of Japan, current host of the G20, is committed to the eradication of polio, providing US$ 563 million in grants to the GPEI since 1988.

Read the Okayama Declaration of the G20 Health Ministers.

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Reposted with permission from Rotary International

Vaccinating every child is the best way to end polio. © Rotary International.
Vaccinating every child is the best way to end polio. © Rotary International.

Five core partners— Rotary International, World Health Organization (WHO), Rotary International, the US Centers for Disease Control and Prevention (CDC), United Nations Children’s Fund (UNICEF), and the Bill & Melinda Gates Foundation— 20 million volunteers, over 2.5 billion children vaccinated, and an initiative spanning over 30 years across 200 countries.

These are the impressive numbers, people power, and the resources behind one of the biggest public-private partnerships in history: The Global Polio Eradication Initiative.

But why is polio eradication a global public health cause transcending generations, geographical boundaries, and socio-cultural constructs? Read on:

Poliovirus causes acute, non-persistent infections  
The virus causes acute, short term infections, meaning that a person infected with polio can only transmit the virus for a limited amount of time.  Prolonged infection with wild polioviruses has never been documented and in most cases infected people can only transmit the virus for 1-2 weeks.

Virus is transmitted only by infectious people or their waste
Some diseases can be transmitted in a multitude of ways, which can make a disease an impossible candidate for eradication. But the poliovirus is typically transmitted just one way: through human waste. Eradicating polio is not an easy task, but the way polio is transmitted simplifies our ability to tackle the disease.

Survival of virus in the environment is finite
Did you know there’s just one strain of wild poliovirus that continues to infect humans? (There used to be three strains of poliovirus that regularly infected humans.) The wild poliovirus cannot survive for long periods outside of the human body. If the virus cannot find an unvaccinated person to infect, it will die out. This is why we have to keep every single child vaccinated—so the virus cannot find any humans to infect. The length of poliovirus survival varies according to conditions like temperature, and the poliovirus infectivity decreases over time.

People are the only reservoir
Hundreds of diseases can be transmitted between insects, animals and humans. One of the things that makes polio eradicable is the fact that humans are the only reservoir. No poliovirus has been found to exist and spread among animals despite repeated attempts to document this.

Immunization with polio vaccine interrupts virus transmission
Not only are there two safe and effective polio vaccines, but vaccination against polio generates herd immunity, which increases the percentage of the population that is immune to the disease.

Mass campaigns using oral polio vaccine, where all children in a specified geographic area are immunized simultaneously, interrupts wild poliovirus circulation by boosting population immunity to the point that transmission of polio cannot be sustained.

But what truly drives our conviction in numbers results. Since the world took up the cause of eradicating polio globally in 1988: we have eliminated polio from 125 countries and reduced the global incidence of polio cases by 99%; and, successfully eradicated certain strains of the virus.

There are now only 3 countries that have never stopped polio transmission. This marathon of a public health endeavour is in the last mile.

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The indelible purple ink on the finger means that two-year Rajesh is protected against polio. © WHO Pakistan/ Asad Zaidi.
The indelible purple ink on the finger means that two-year Rajesh is protected against polio. © WHO Pakistan/ Asad Zaidi.

On the long road to global polio eradication, the programme has achieved four important milestones, representing four out of six WHO regions that have been certified as having interrupted transmission of wild poliovirus (WPVs):  Region of the Americas (1994), the Western Pacific Region (2000), the European Region (2002), and the South-East Asia Region (2014).

At present, only the Eastern Mediterranean and African regions—  no WPV reported in Africa since 2016, the African region may be eligible for regional certification as early as late 2019—remain to be certified in the path towards global eradication and hence constitute a key priority.

But who decides that a region is free of WPV?

The Eastern Mediterranean Regional Commission for Certification of Poliomyelitis Eradication (ERCC) is an independent body appointed in 1995 by the WHO Regional Director for Eastern Mediterranean to oversee the certification and containment processes in the region.  It is the only body with the power to certify the Region free from wild polio, which convenes annually. Here are the outcomes of the recent ERCC meeting:

Urgent need to address regional priorities

The Commission noted with concern the need to stop the ongoing wild poliovirus type 1 transmission in the only two remaining polio-endemic countries in the Region: Afghanistan and Pakistan. The RCC acknowledged the on-going eradication efforts but strongly recommended the full implementation of the respective national emergency polio programmes through complete political and programmatic support to tackle the WPV1 transmission in the common Pak-Afghan epidemiological corridor, which remains unabated. The Commission also expressed concern about the current circulating vaccine-derived poliovirus type 2 and 3 transmissions in Somalia.

Wild poliovirus type 3 certification prospects

The Commission, however, marked the good progress made towards curbing wild poliovirus type 3 (WPV3). Extensive analyses of the stool and environmental surveillance samples provided evidence that no WPV3 is in transmission in the Region. Based on the epidemiology, EMRO – along with the rest of the world – may be up for global WPV3-free certification by the GCC, potentially certifying two of three poliovirus strains eradicated—WPV2 strain was certified as globally eradicated in 2015.

Stepping-up is the need of the hour

So far, sixty cases of WPV1 are reported from two countries (Pakistan and Afghanistan) in 2019. Given the existing WPV1 transmission in the two remaining endemic countries of the Region, the RCC asked that the Member States undertake a firm commitment necessary for reaching zero.

Eastern Mediterranean Regional Commission for Certification of Polio Eradication (ERCC)

The Thirty-third meeting of the EMRO RCC was held in Muscat, Oman, to discuss the Regional progress towards a polio-free certification. The meeting brought together members of the RCC, chairpersons of the National Certification Committees, polio programme representatives of 21 countries, and WHO staff from the headquarters, regional, and the endemic countries. Representatives from Rotary International and the Centers for Disease Control and Prevention were also in attendance.

Comprised of public health and scientific experts, the regional certification commissions are independent of the WHO and national polio programmes.  Global certification will follow the successful certification of all six WHO regions and will be conducted by the Global Certification Committee (GCC).

Read more.

Final reports of the annual Eastern Mediterranean Regional Certification Commission intercountry meetings.

72nd World Health Assembly. ©WHO/L.Cipriani
72nd World Health Assembly. ©WHO/L.Cipriani

Polio eradication was in high-level spotlight this week in the top echelons of global leadership as World Health Organization (WHO) Member States, donors, partners, civil society organizations, health and development actors gathered this week at the 72nd World Health Assembly (WHA) in Geneva, Switzerland.

In his opening address to delegates, WHO Director-General and Chair of the Polio Oversight Board (POB), Dr Tedros Adhanom Ghebreyesus talked about the long-winding journey of polio eradication since its adoption as a landmark resolution at the WHA in 1988 and the hopes of finishing eradication in the near future: “Together with our partners at Rotary, CDC, UNICEF, the Bill & Melinda Gates Foundation and Gavi, the Vaccine Alliance in the Global Polio Eradication Initiative, we have launched a new strategy to address the most difficult remaining areas in Afghanistan and Pakistan. Earlier this year I came across a video of a man called Irfanullah, wading through snow to deliver polio vaccines in Pakistan. With the dedication and commitment of people like him, I have no doubt we will succeed in making polio history.”

Member States expressed overwhelming support of the Polio Endgame Strategy 2019-2023.  The new strategy sets the stage for a decisive win against polio through the parallel pursuit of the wild poliovirus and circulating vaccine-derived poliovirus. The Strategic Plan incorporates collaboration with other health interventions, fostering stronger alliances and managerial innovations by working in close coordination with governments in endemic countries. The Member States welcomed the trifecta of Eradication, Integration, and Containment/Certification, which set the foundations of a sustainable polio-free world by anchoring polio activities within the broader immunization system, ensuring an effective transition of eradication knowledge and assets and ensuring that no poliovirus can paralyze children again.

With an eye towards an inclusive and sustainable polio-free future, there was broad consensus that all stakeholders—governments, GPEI partners, private and public donors, policy makers, health, and non-health actors— are in this together.  One of the recurring themes was the need to ensure concerted efforts—financial and programmatic— to get over the hump in this last mile over to the finish line.

The general air was that of cautious optimism, as all Member States acknowledged that the path to finishing polio eradication is well within sight, all thanks to the Endgame Plan 2013-2018 which succeeded in certifying South-East Asia (SEARO) as polio-free, brought the African Region closer than ever to eradication of wild poliovirus,  possibly eradicated two out of three wild poliovirus strains, set the world on the path of phased Oral Polio Vaccine (OPV) removal, stopped outbreaks in Syria and Horn of Africa, and cornered wild poliovirus circulation to a joint cross-border reservoir between Afghanistan and Pakistan.

The delegates particularly appreciated the strong commitments espoused by Afghanistan and Pakistan for a more systematic collaboration to jointly target the common wild poliovirus reservoir on all fronts with an approach that combines the scientific with the social and anthropological. Pakistan’s representative said, “We remain resolute with the highest level of political commitment… strengthening routine immunization, addressing prevalent malnutrition, and provision of safe water and sanitation are strategies being implemented in tandem. Communication challenges of low-risk perception and concerns around vaccine safety and efficacy are being addressed through a revised communication strategy. We continue to coordinate with Afghanistan programme to share experience in strategies to manage the common epidemiological block. In light of the recent cases, the Government of Pakistan has decided to carry out a comprehensive programme review on an urgent footing. I would like to sincerely thank our partners and donors who are a part of this initiative and helped us get this far. We pledge our complete commitment to reach every last child, so no future generations have to suffer from a crippling disease like polio.”

Rotary International, one of the pioneering partners of the GPEI, maintained that wild poliovirus eradication remains the overriding priority, and to that end, re-affirmed collective commitment of their 1.2 million members around the world: “It is easy to forget the hurdles we have overcome—such as: addressing outbreaks in more than 20 countries in Africa, or how India had 80% burden of the total polio caseload in the world. Our challenge is not feasibility, but determination…global commitment has brought us to the threshold of a polio-free world. Let us act with urgency to end polio forever.”

In his closing remarks, Dr Tedros thanked the Crown Prince of Abu Dhabi and the United Arab Emirates for hosting a pledging moment for the Global Polio Eradication Initiative, “Global progress to end polio would not be possible without partners like the UAE. I would like to thank His Highness Sheikh Mohamed bin Zayed Al Nahyan, Crown Prince of Abu Dhabi, and the UAE – a long-time supporter of the polio programme – for agreeing to host the GPEI pledging event this November at the Reaching the Last Mile Forum, a gathering of leaders from across the global health space.”

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Dr Rebecca Martin, Centers for Disease Control and Prevention, delivering the welcome address at the event ”To succeed by 2023—Reaching Every Last Child for a Polio-free World” to celebrate the launch of the Polio Endgame Strategy 2019-2023. ©WHO.
Dr Rebecca Martin, Centers for Disease Control and Prevention, delivering the welcome address at the event ”To succeed by 2023—Reaching Every Last Child for a Polio-free World” to celebrate the launch of the Polio Endgame Strategy 2019-2023. ©WHO.

The 72nd World Health Assembly, the governing body of the World Health Organization held by in Geneva, Switzerland is the biggest congregation of public health actors. Taking advantage of the critical mass of global leaders, the Global Polio Eradication Initiative hosted an event for polio eradicators, partners and stakeholders on 21 May 2019.

The event, To Succeed by 2023—Reaching Every Last Child, celebrated the GPEI’s new Polio Endgame Strategy 2019-2023. The five-year plan spells out the tactics and tools to wipe out the poliovirus from its last remaining reservoirs, including innovative strategies to vaccinate hard-to-reach children and expanded partnerships with the Expanded Programme on Immunization (EPI) community and health emergencies.

The informal event brought together a cross-section of stakeholders – partners, health actors, non-health actors, supporters, donors, Ministers of Health of endemic countries, WHO Regional Director for the Eastern Mediterranean, and Polio Oversight Board members – alluding to strengthened and systematic collaboration in areas of management, research and financing activities in the last mile.

Dr Zafar Mirza, Pakistan’s Minister of State,Ministry of National Health Services, Regulations, and Coordination, seen with Seth Berkley, CEO of Gavi, the Vaccine Alliance, at the GPEI informal event during the 72nd World Health Assembly. ©WHO
Dr Zafar Mirza, Pakistan’s Minister of State,Ministry of National Health Services, Regulations, and Coordination, seen with Seth Berkley, CEO of Gavi, the Vaccine Alliance, at the GPEI informal event during the 72nd World Health Assembly. ©WHO

Dr Zafar Mirza, Pakistan’s Minister of State,Ministry  of National Health Services, Regulations and Coordination, took the stage and gave insight into country-level polio eradication efforts and the need for coordinated action with Afghanistan: “20 years ago, 30 000 children were paralyzed by polio in Pakistan. This year, 15 cases have been reported. While we have done a lot, it is clearly not enough. We are resolute in this conviction. We, together with Afghanistan, must make sure we eradicate polio for the sake of our children. Our science is complete, only our efforts are lacking. Along with the polio programme, the donors and the Afghan government, we will get to the finish line.”

Echoing similar sentiments, Dr Ferozuddin Feroz, Minister of Public Health of Afghanistan, said, “I would like to start by expressing thanks to all the partners for their support. As you know, Afghanistan has a very challenging context due to inaccessibility, refusals, gaps in campaign quality, low routine immunization coverage, and extensive cross-border movement. But, Afghanistan has made progress—five out of seven regions continue to maintain immunization activities. We view polio as a neutral issue and have developed a robust National Emergency Action Plan 2019. We appreciate the Polio Endgame Strategy 2019-2023. We believe coordination with Pakistan will help us deliver a polio-free world. We look forward to your continued technical and financial support to achieve the goal of polio eradication.”

Dr Ferozuddin Feroz, Minister of Public Health, Afghanistan, talking about the remaining challenges for polio eradication and the need for continued partner support in the last mile. ©WHO
Dr Ferozuddin Feroz, Minister of Public Health, Afghanistan, talking about the remaining challenges for polio eradication and the need for continued partner support in the last mile. ©WHO

Recognizing the long-standing commitment of the United Arab Emirates, a video was played showing the on-ground efforts of the Emirates Polio Campaign, working with communities and families in Pakistan in collaboration with the Global Polio Eradication Initiative and partners, and the Government of Pakistan. Thanks to the Emirates Polio Campaign, 71 million Pakistani children have been reached with 410 million doses of polio vaccine.

Dr Abdullahi Garba, Director for Planning, Research and Statistics, National Primary Healthcare Development Agency spoke on behalf of Professor Isaac F Adewole, Federal Minister of Health of Nigeria. Dr Garba harked back to the past as the GPEI plans for the future: “Nigeria started actively working to eradicate polio in 1988, at a time when we used to have up to a thousand cases every year. With all our innovation and efforts, I am pleased to inform you today that no wild polio case has been detected for the past 33 months. This feat was achieved through continuous efforts between the government, GPEI and partners, having diligent incidence reporting, reaching inaccessible children, and improving the quality of the polio surveillance immunization activities through strong oversight mechanisms in Nigeria. I know I also speak on behalf of all countries across Africa – we will achieve success.”

Representing Nigeria, Dr Abdullahi Garba, Director for Planning, Research and Statistics, National Primary Healthcare Development Agency, talked about the challenges, innovations and tools used to bring Nigeria to the brink of polio eradication. ©WHO
Representing Nigeria, Dr Abdullahi Garba, Director for Planning, Research and Statistics, National Primary Healthcare Development Agency, talked about the challenges, innovations and tools used to bring Nigeria to the brink of polio eradication. ©WHO

Rounding off the evening, Dr Tedros Adhanom Ghebreyesus, the World Health Organization Director-General and Chair of the GPEI Polio Oversight Board, took the stage to recount his first visit of the year to the polio endemic countries of Afghanistan and Pakistan, the progress made over decades, and the need to re-commit to the cause of ending polio. “Together with Regional Director Ahmed Al-Mandhari and Chris Elias of the Gates Foundation, we travelled to Pakistan and Afghanistan. We saw first-hand the commitments by both public and civil society leaders, which gave us a lot of confidence. The other thing that gave us confidence was seeing our brave health workers trudging through deep snow. And of course, our partners:  Rotary, United Arab Emirates, CDC, UNICEF, the Bill & Melinda Gates Foundation and Gavi. The last 30 years have brought us to the threshold of being polio-free…(which) lay out the roadmap that is the Polio Endgame Strategy 2019-2023. The Ministers of Afghanistan and Pakistan have also assured us that they will continue to work together in their shared corridor to finish polio once and for all.”

Dr Tedros Adhanom Ghebreyesus, the World Health Organization Director-General and Chair of the GPEI Polio Oversight Board, remains confident in continued political commitment in the endemic countries, the tireless support of partners, donors, and the Polio Endgame Strategy 2019-2023 to deliver a polio-free world. ©WHO

In 1988, the World Health Assembly passed a resolution to globally eradicate poliovirus, in what was meant to be “an appropriate gift…from the twentieth to the twenty-first century.”

As the GPEI plans for the future and its final push to ‘finish the job,’ it is clear that political and financial efforts need to ramp up in this increasingly steep last mile. As he concluded, Dr Tedros thanked committed partners like United Arab Emirates: “Global progress to end polio would not be possible without partners like the UAE. I would like to thank His Highness Sheikh Mohamed bin Zayed Al Nahyan, Crown Prince of Abu Dhabi, and the UAE – a long-time supporter of the polio programme – for agreeing to host the GPEI pledging event this November at the Reaching the Last Mile Forum, a gathering of leaders from across the global health space held once every two years…let us join together to end polio.”

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Today, the Global Polio Eradication Initiative (GPEI) launched the Polio Endgame Strategy 2019-2023, which will guide the programme and its partners to overcome the final hurdles to eradication and move toward sustaining a polio-free future.

A child being vaccinated in Sudan's Darfur region © Jean-Marc Giboux
A child being vaccinated in Sudan’s Darfur region © Jean-Marc Giboux

The new plan hones in on addressing today’s most pressing obstacles to end poliovirus transmission imminently, integrate polio programme resources into health and development programmes globally, and certify the world polio-free. In addition to building on the programme’s core strategies to expand access to vaccination and improve surveillance around the world, the 2019-2023 Endgame Strategy offers responsive and innovative solutions tailored to communities’ needs. These include establishing a regional hub in Amman, Jordan to enhance coordinated support to Afghanistan and Pakistan and creating permanent Rapid Response Teams to accelerate the programme’s response to outbreaks.

The programme will also work to improve immunisation coverage and support basic development needs through strengthened collaboration with immunisation partners such as Gavi, the Vaccine Alliance and the humanitarian and emergency response communities.

To reach its goals and achieve eradication, the Endgame Strategy requires a US$4.2 billion budget, of which US$3.27 billion is to be raised by the GPEI. In support of the Strategy and to encourage additional commitments, a pledging event will be hosted this November at the Reaching the Last Mile Forum in Abu Dhabi, a gathering of leaders from across the global health space held once every two years. The pledging event will be hosted by the GPEI, with the support of His Highness Sheikh Mohamed bin Zayed Al Nahyan, Crown Prince of Abu Dhabi, a longtime champion of the polio programme.

A polio team doing marking a door in Ravi Town, Lahore during NID III © WHO/A.Khan
A polio team marking a door in Ravi Town, Lahore during NID III © WHO/A.Khan

The 2019-2023 Endgame Strategy builds on the 2013-2018 Strategic Plan, which brought the world to the brink of polio eradication. Despite this impressive progress, the last steps to eradication have proved to be the most difficult.

Wild poliovirus transmission continues in Afghanistan and Pakistan, and circulating vaccine-derived poliovirus outbreaks are ongoing in several countries across Africa and Asia. To overcome these challenges, the new Strategy must be fully implemented with sufficient resources and commitments from governments, donors, multilateral organisations, and local communities.

The Polio Endgame Strategy 2019-2023 was discussed at the 2019 World Health Assembly in Geneva, Switzerland during the week of 20 May.

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