GPEI-Want a community’s trust? Start by listening

Community Health Workers deliver polio vaccine in Pehlwan Goth in Karachi. ©PEI/2020

Welcome to Pehlwan Goth, Pakistan. A low-income neighbourhood on the edge of Karachi city, it is home to many families from Khyber Pakhtunkhwa province who have moved here for work.

An open sewage drain lined with litter runs the length of the settlement. Cattle are often seen grazing near the heaps of garbage. It is a high-risk area for polio, and virus is regularly detected in the environment.

Samreen, a 25-year-old Polio Area Supervisor, leads a team of four community health workers in the area.

“I started working with the Polio Eradication Programme four years ago and I am happy to say that we have made a lot of progress here. This is my neighbourhood; this is where I grew up and this helps me immensely. People here listen to me, especially the women, and I know most of the children by name,” says Samreen.

Converting refusals

There are around 32,000 children under five years of age in Pehlwan Goth. In April 2019, parents of around 3,000 children refused the polio vaccine. Through the hard work of supervisors like Samreen however, now over 80% of these children have received vaccines.

“I am in charge of an area that has 210 households with 196 children. In 2019, families of more than 50 children refused vaccines. That’s almost one fourth of all the children in my area,” said Samreen.

Samreen delivers polio drops to children whose parents initially rejected vaccination. ©PEI/2020

“Building trust takes time, and we continued engaging with community members, visiting families, listening to their concerns, and explaining the benefits of vaccination. Today, we have only eight refusal cases out of the previous 50. I will try my level best to bring this number down to zero during the polio campaign next month.”

“But for me, it is not just about just converting refusals during every campaign, I want all families to understand the benefits of vaccines in the long run and ensure the immunization of their children against polio and other diseases.”

Her rapport with families is apparent during house visits. A family with three children, who had refused vaccination in previous months, agreed that their children could this time receive the life-saving polio drops.

Confronting misconception

Building trust with the community has not been an easy task. Samreen is supported by a social mobilizer as well as a local religious support person. The team members work together to address misconceptions and raise awareness of good health practices among caregivers in Pehlwan Goth.

Samreen and Maulana Mohammad Hanif vaccinate the children of local resident Tayyab Khan. ©PEI/2020

“We speak the same language and our homes are in the same area where we work. It is easier to communicate with people when you are part of the same community,” said Maulana Mohammad Hanif, the religious support person in Samreen’s team.

Sometimes, however, it can take only one negative social media video or news item to reignite refusals and overturn all their efforts.

“The process takes time. The work is tough but I am grateful to Allah for this job, which allows me to feed my family, and contribute to a noble cause, which will save future generations of Pakistanis,” added Maulana Mohammad Hanif.

It’s clear that Samreen and her team will do whatever it takes to deliver a polio-free future to all 196 children in their care. Pakistan and Afghanistan are the final two polio endemic countries in the world and there are still many challenges that remain.

It is the local efforts of teams like Samreen’s that will make all the difference – by listening to communities, building trust and ensuring rapport, they are playing a crucial role to bring their country closer to ending polio.

In July

722,500 children were vaccinated during the SNID campaign.

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Dr. Ana Elena Chevez with her medical school cohort in El Salvador. During her career, Dr. Ana has made an immense contribution to polio eradication and broader public health. Credit: Provided by Dr. Ana Elena Chevez

Little Ana first learned about the importance of vaccines from her father, a pediatrician. Growing up during El Salvador’s 12-year civil war meant that electricity cuts were a common occurrence. Whenever the electricity went out, Ana’s father would rush the vaccines he kept in his clinic to the nearby hospital, where generators kept the cold chain refrigerators working. Seeing her father’s dedication to his work, Ana knew she would also become a doctor.

Fast-forward to 2020. Dr. Ana Elena Chevez has dedicated over twenty years of her life to protecting children from vaccine preventable diseases. She has worked in four countries across two regions, and currently serves as a Regional Immunization Advisor for polio at the Pan American Health Organization (PAHO), the Regional Office for the Americas of the World Health Organization, supporting the 52 countries and territories of the Americas to maintain polio-free status.

Throughout her career, she has never stopped dreaming high – advice given to her by family, mentors and colleagues.

Dr. Ana’s first job in public health was as a national immunization manager in El Salvador. Her mentor was PAHO/WHO immunization advisor Dr. Salvador Garcia. “Dr. Garcia taught me everything I needed to know about running an immunization programme. I knew that I could call him at any time, and I would get the answer that I needed,” she said.

The last mile of polio eradication in Nigeria

As polio cases surged in the African region in 2007, Dr. Ana was selected to go to Nigeria to support outbreak response. In a twist of fate, a three-month assignment turned into four years as Nigeria’s Supplementary Immunization Activity (SIA) coordinator.

It was in Nigeria that Dr. Ana refined her skills as a polio eradicator, as well as finding a ‘home away from home’. Credit: Dr. Ana Elena Chevez

This experience was pivotal for Dr. Ana’s career – it solidified her passion for polio eradication and introduced her to new colleagues and a new

country, which would soon become Dr. Ana’s second family and her home-away-from-home.

Dr. Ana was inspired by the constant innovation she saw in Nigeria. “We were always looking for ways to improve quality of the campaigns – improve training, surveillance, cold chain. It was always innovation, innovation, innovation.”

Dr. Ana believes that way of thinking really took Nigeria to the next level. “We started seeing fewer cases, more children vaccinated, and a higher level of acceptance among parents and leaders.”

As SIA coordinator, Dr. Ana oversaw all polio campaigns in the country. During these years, polio campaigns were happening on an almost monthly basis, alongside campaigns for yellow fever, tetanus elimination, and measles. It was overwhelming. “By the time we returned from the field to analyze one campaign, it was already time to start preparation for the next one. It was tiring for everyone – for us (the WHO staff), the partners, for the national/state/local health authorities, and of course for the vaccinators.”

Despite the pressure, Dr. Ana said, “If you were to ask me if I would do it again, I would say yes in a heartbeat. For me, it was being a part of an important moment in history – for the country, for public health, and for the polio programme.”

Maintaining momentum in a region certified free of polio for over 25 years

In 2017, Dr. Ana became PAHO/WHO’s Regional Advisor in charge of polio. The last case of wild poliovirus in the Americas was in 1991 and the region was certified free of polio in 1994. Although more than 25 years have passed since the Americas received polio free status, until polio is eradicated everywhere, the disease is still a risk.

25 years since the Americas were certified polio-free, Dr. Ana emphasizes that the region remains at risk until polio is eradicated everywhere. Credit: Dr. Ana Elena Chevez

Dr. Ana explains, “Even though new generations of nurses, doctors, and epidemiologists have not seen a case of polio firsthand, they understand the risk remains.” There have been 26 meetings of PAHO’s Technical Advisory Group (TAG) meeting on vaccine preventable diseases, and polio has been included on the agenda for every meeting.

It has not always been easy to keep this momentum. In recent years, countries in the Americas have had trouble meeting the indicators required to prove sensitive surveillance systems. For the last few years, PAHO has been holding almost yearly regional polio meetings to sensitize countries on the GPEI’s requirements for eradication and stress the importance of achieving high immunization coverage rates for polio and high standards of surveillance.

Dr. David Salisbury, chair of the Global Certification Commission for Polio Eradication, said at the regional PAHO polio meeting in 2017 that “there will be no free pass” for countries that are polio-free. All nations must provide documentation of certification standard surveillance to back up their belief that polio is eliminated amongst their population.

For Dr. Ana, these words hit home, “The work done by those that here before me has helped the countries to be aware. It has been my role to keep that momentum alive and help countries meet the required goals established in the Endgame Strategy.”

A message for the new generation of women public health leaders

In recent decades, women leaders in public health and immunization made important contributions to a field once dominated by men.

Dr. Ana recalls many of the women leaders that she’s worked with and considers that they have gone above and beyond what is expected. “They have raised the bar and have given the message that other women can work in public heath – it doesn’t matter your religion or colour – it matters that you care.”

Dr. Ana is excited to see more women step into leadership roles. “The new generation is coming. We need them – we need to prepare them. We are close to polio eradication, but we must think about what is next and prepare the new generation to tackle these issues with confidence. I tell my nieces that they can go and contribute to the world and make an impact.”

Reflecting on her own motivation, Dr. Ana says, “I always believed that I could make an impact, I just needed the tools, time and opportunity.”

“Young women leaders: Keep dreaming high. Keep dreaming that you can influence the health of whole populations. Don’t be afraid to set high goals– don’t be afraid to think that it is possible to control, eliminate, or even eradicate a disease.”

Nabeela, a polio frontline worker in Pakistan, vaccinates a child in Liaqatabad using the ‘no touch’ method. © UNICEF/Pakistan

Vaccinators in countries including Afghanistan, Angola, Burkina Faso and Pakistan took to the streets this month to fill urgent immunity gaps that have widened in the under-five population during a four month pause to polio campaigns due to COVID-19.

Campaigns resumed in alignment with strict COVID-19 prevention measures, including screening of vaccinators for symptoms of COVID-19, regular handwashing, provision of masks and a ‘no touch’ vaccination method to ensure that distance is maintained between the frontline worker and child. Only workers from local communities provided house-to-house vaccination to prevent introduction of SARS-CoV2 infection in non-infected areas.

Although necessary to protect both health workers and communities from COVID-19, the temporary pause in house-to-house campaigns, coupled with pandemic-related disruptions to routine immunization and other essential health services, has resulted in expanding transmission of poliovirus in communities worldwide. Modelling by the polio programme suggests a potentially devastating cost to eradication efforts if campaigns do not resume.

A child has their finger marked during the campaign in Angola. ©WHO/AFRO

In Afghanistan, 7858 vaccinators aimed to vaccinate 1 101 740 children in three provinces. Vaccinators were trained on COVID-19 infection control and prevention measures and were equipped to answer parents’ questions about the pandemic. Through the campaign, teams distributed 500 000 posters and 380 000 flyers featuring COVID-19 prevention messages.

In Angola, 1 287 717 children under five years of age were reached by over 4000 vaccinators observing COVID-19 infection prevention and control measures. All health workers were trained on infection risk, and 90 000 masks and 23 000 hand sanitizers were distributed by the Ministry of Health.

In Burkina Faso, 174 304 children under five years of age were vaccinated in two high-risk districts by 2000 frontline workers. Vaccinators and health care workers were trained on maintaining physical distancing while conducting the vaccination. 41 250 masks and 200 litres of hand sanitizer were made available through the COVID-19 committee in the country to protect frontline workers and families during the campaign.

In Pakistan, almost 800 000 children under the age of five were reached by vaccinators in districts where there is an outbreak of circulating vaccine-derived poliovirus. Staff were trained on preventive measures to be followed during vaccination, including keeping physical distance inside homes and ensuring safe handling of a child while vaccinating and finger marking them.

Farzana, a polio worker in Karachi’s Liaqatabad Town, Pakistan uses hand sanitizer during the campaign. ©UNICEF/Pakistan

“Our early stage analysis suggests that almost 80 million vaccination opportunities have been missed by children in our Region due to COVID-19, based on polio vaccination activities that had to be paused,” said Dr Hamid Jafari, Director for Polio Eradication in the Eastern Mediterranean Region. “That’s close to 60 million children who would have received important protection by vaccines against paralytic polio.”

Over the coming months, more countries plan to hold campaigns to close polio outbreaks and prevent further spread, when the local epidemiological situation permits.

“Our teams have been working across the Region to support the COVID-19 response since the beginning of the pandemic, as well as continuing with their work to eradicate polio,” said Dr Hamid Jafari. “We must now ensure that we work with communities to protect vulnerable children with vaccines, whilst ensuring strict safety and hygiene measures to prevent any further spread of COVID-19”.

In Afghanistan, 7858 vaccinators aimed to vaccinate 1 101 740 children in three provinces. ©WHO/Afghanistan

Dr Matshidiso Moeti, WHO Regional Director for Africa, commented, “We cannot wait for the COVID-19 pandemic to be contained to resume immunization activities. If we stop immunization for too long, including for polio, vaccine-preventable diseases will have a detrimental effect on children’s health across the region.”

“The campaigns run by the Polio Eradication Programme demonstrate that mass immunization can be safely conducted under the strict implementation of COVID-19 infection prevention and control guidelines.”

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Community surveillance teams for COVID-19 and acute flaccid paralysis speak to households about any individuals with symptoms in their area. The Somali polio team is currently steering the COVID-19 response and fighting ongoing polio outbreaks amidst challenging conditions. ©WHO/Somalia

For Somalis, COVID-19 is the most immediate crisis in a seemingly unending cycle of floods, food insecurity, conflict and outbreaks of vaccine-preventable diseases like measles, cholera and polio. Against this backdrop, the World Health Organization’s polio programme is working to steer the COVID response and, more broadly, maintain vaccine immunity levels and improve access to healthcare. It’s no easy feat.

Dr Mohamed Ali Kamil, the outgoing World Health Organization Polio Team Lead and COVID-19 incident manager for Somalia, is in awe of the commitment shown by health staff. He recently phoned a Polio Logistician diagnosed with COVID-19 who was experiencing symptoms, to insist he stop working remotely from his sickbed. Dr Kamil recalls, “He said, “No Sir, I will continue.”

Since the first COVID-19 case was diagnosed in Somalia on 16 March 2020, the polio programme has fought the pandemic from the ground up. Dr Kamil explains, “No other health programme has comparable expertise to serve the Somali population during COVID-19. During their time in the programme, members of the polio team have responded to many different disease outbreaks. This means they were well placed and well trained to respond to COVID-19.”

“The polio programme has spent years building staff capacity and systems to implement vaccination campaigns and detect the poliovirus in the community. In some ways, the team are the first and last line of defense.”

The response includes education, case identification, contact tracing, case management and data support. As of June, polio staff working as part of rapid response teams (RRTs) had reached 2.6 million people with messages about COVID-19 prevention. District Polio Officers within the RRTs have led the investigation of over 4500 people with suspected COVID-19 across the country. The country has set up three COVID-19 testing facilities and the polio structure established for the collection and shipment of stool samples from AFP cases has been used for the transportation of COVID-19 samples.

Dr Mohamed Ali Kamil, the outgoing World Health Organization Polio Team Lead and COVID-19 incident manager for Somalia, speaks to a polio vaccinator before the onset of the pandemic. ©WHO/Somalia

Throughout, polio personnel have continued their full-time work to end the circulating vaccine-derived poliovirus (cVDPV) outbreaks that have thus far paralyzed sixteen children since 2017.

The team are driven by a humanitarian commitment to the Somali population, who have suffered over 30 years of protracted conflict and insecurity. At least 5.2 million people are in need of humanitarian assistance, and secondary and tertiary healthcare is virtually non-existent outside of a few large cities. Health literacy is low, and populations are highly vulnerable to diseases like polio, measles, cholera and now COVID-19. In November 2019, widespread flooding brought further turmoil and danger to Somali families.

The team’s work is made more difficult by the emotional toll wrought by the pandemic. To date at least 143 health workers have been identified with COVID-19 infection. In April, Ibrahim Elmi Mohamed, a District Polio Officer who spent 19 years striving for a polio-free Somalia, died of a COVID-19-related illness. His death, one of many frontline staff around the world due to COVID-19, remind us of the risks they face every time they go to work.

Challenges lie ahead to defeat polio

Dr Kamil is clear that the polio programme will require ongoing funding and the support of authorities, partners and communities in order to maintain polio activities amidst the pandemic.

“To sustain the immunity gains we must implement a number of polio vaccination campaigns each year until the routine immunization programme can reach every Somali child with all polio vaccines. Somalia is extremely fragile and at high risk of becoming endemic for poliovirus if we do not maintain and support the polio infrastructure,” he says.

Since the cVDPV outbreaks were first detected in 2017, the programme has streamlined disease surveillance for cases of acute flaccid paralysis and other preventable diseases, including by introducing mobile technology to record details of suspected cases. For the first time, environmental disease surveillance was introduced. Over three years, frontline health workers have implemented more than 15 polio campaigns, including integrated campaigns with the measles programme.

A volunteer vaccinator gives two drops of the polio vaccine to a Somali child in August 2019. Despite efforts, many inaccessible areas remain where the programme cannot deliver vaccines. ©WHO/Ilyas Ahmed

Dr Kamil explains, “We still don’t know where the virus is coming from exactly. There are many inaccessible areas, where we cannot deliver vaccines or respond with immunization campaigns. We suspect that the virus is circulating among vulnerable children and communities living in these areas.”

Dr Kamil feels strongly that the polio programme has a duty to support other health interventions. He says, “COVID-19 shows what the frontline polio staff can achieve and the strength of surveillance and response systems.’’

Despite the challenges, Dr Kamil retains his belief that with ongoing funding and support, the cVDPV outbreaks in Somalia can be brought to a close. He reflects, “COVID-19 is a huge emergency in Somalia. Our staff are working flat out, and we expect to see many more cases, but at the same time we must continue to fight polio. The Somali community and the world deserve to be free of this disease.”

“We must reschedule our March polio vaccination campaign which was delayed because of the COVID 19 outbreak. We must do everything possible to keep health workers safe from COVID-19. It’s a hard situation, but we must not stop until we overcome both viruses.”

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In May

1 case of wild poliovirus were reported
318 children were vaccinated.
Polio vaccination activities continued to stay postponed due to COVID-19 outbreak

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Dr Fiona Braka has spent 17 years working to eradicate polio in the African Region. ©WHO Nigeria

Dr Fiona Braka holds one of the highest-stake roles in the African regional polio programme – supporting the Government of Nigeria in their fight to defeat wild poliovirus.

She is the first woman to hold her position in Nigeria, and before that was the first female polio team lead in Ethiopia.

Fighting the last wild virus in Africa

Dr Braka’s work involves leading the country team to strengthen routine immunization and maintain high quality disease surveillance systems in Nigeria. She is also heavily involved in the COVID-19 response, lending expertise established over decades of fighting polio.

In 2016, the detection of wild virus in Nigeria after nearly two years without cases was a devastating setback. “When the outbreak broke out, I was in Uganda on a break with my family. I was having lunch with a friend and my phone was ringing, persistently ringing – a Geneva number. When I picked up the phone it never crossed my mind it would be a wild virus,” Dr Braka remembers.

“A good proportion of Borno state was inaccessible due to armed conflict. Delivering vaccination services and conducting surveillance in that area had not been easy. With interventions going on to address the conflict by the Nigerian Government, some ground was gained, and people trapped for over three years were able to move out of the liberated areas to internally displaced persons camps. With population movement, a wild polio case was detected in an internally displaced child.”

Cutting short her family holiday, Dr Braka raced to Borno to help launch a truly innovative outbreak response with the government and partners. Adapting strategies for polio response to an insecure setting, the programme started settlement-based microplanning guided by local security assessments, innovative surveillance approaches, and the use of GIS and satellite imagery to estimate trapped populations.

The estimated number of children inaccessible to vaccinators has dropped from over 400,000 in September 2016 to less than 30,000 in May 2020 – an enormous achievement for the programme.

Dr Braka is passionate about equal participation and leadership in public health. ©WHO/Nigeria

Balancing motherhood and a career in public health

The challenges were very different when Dr Braka was working on the 2013 Horn of Africa outbreak in Ethiopia’s Somali region. Cases of polio were occurring among pastoral communities and the programme had to rethink tactics to ensure the children of nomadic populations could be reached with vaccines. To maintain the cold chain, polio teams travelled on donkeys or on foot through the bushes. Community leaders among the nomads were employed to help vaccination teams reach families on the move.

“I recall the advice of a parent of a nomadic child who had contracted polio. He said, “We follow where the clouds and rain go – unless the polio programme also moves with the clouds and the rains as we do, you will never reach us and our children will never get the vaccine”. This became a guiding quote for us,” Dr Braka remembers.

This was also a time of personal challenge, as Dr Braka’s youngest daughter was less than a year old. On one occasion, Dr Braka brought her baby with her to a vital cross-border collaboration meeting in Somali region between the Somalia, Kenya and Ethiopia teams. She recalls, “I had to stay in the same hotel as the meeting so I could run upstairs during the break to breastfeed. That moment really stands out an example of the tough decisions you must make as a parent.”

Dr Braka praises steps taken so far to promote women’s professional development in public health and leadership, whilst noting there is more to do.

“The WHO Regional Director for Africa, Dr Matshidiso Moeti, has provided opportunities for capacity building for women. There has been the first training this year for senior women leaders in the African region – I am proud to be part of this.”

Part of the Global Polio Eradication Initiative Gender Strategy 2019-23 commits to promoting a gender-responsive organizational culture. By placing gender at the heart of operations, the strategy closely aligns with the policies of major donors to polio eradication including Canada, Germany, Australia and the United Kingdom.

Explaining why she is a strong supporter of gender equality at all levels of public health, Dr Braka finds, “Even occupying leadership roles you have to have gender in mind – you have to be prepared to prove yourself a bit more.”

“It remains our responsibility to create a policy environment that gives opportunities for men and women.”

Dr Braka delivering polio vaccine to children in Borno State during an outbreak response campaign. ©WHO/Nigeria

A duty to end polio

Dr Braka emphasizes that many people forget how damaging the disease is.

“Whilst we have polio anywhere in the world, we are all at risk of cross-border virus spread. Until polio is eradiated globally, we must be on our toes with robust surveillance systems and infrastructure to deliver vaccines.”

Dr Braka has been able to sustain her demanding job in part thanks to the support of her family. She explains, “I have a very supportive spouse…He knows the polio programme as well as I do!”

“My late father was also very supportive of my career. My mother has been more than a mother – a strong pillar of support, mothering her grandchildren when I am not there and providing moral support in the background.”

She explains that she can’t imagine a next generation suffering from polio when a vaccine is available.

“Vaccines are a powerful tool and the evidence is clear for saving lives. They reduce burden on families, economically, emotionally, and they prevent the suffering of children.”

“We have a duty to secure children’s future to be healthy citizens.”

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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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Part of Joana’s role as a nurse involves vaccinating children in Barangay 105 Happyland, Tondo, in the city of Manila. A vaccine-derived poliovirus outbreak was detected in the Philippines in 2019, and health workers are working to close a polio immunity gap present amongst some of the nation’s children. To successfully vaccinate children in Barangay 105 Happyland, the teams speak to community leaders, dodge traffic, and answer the questions of parents about the vaccine.

*This footage was recorded before the introduction of measures to reduce the spread of COVID-19 in the Philippines.

To find out more about the response, please visit WHO’s Polio Outbreak in the Philippines webpage

In March

17.2 million children were vaccinated during the SNID campaign.
0.9 million children were vaccinated at 371 Permanent Transit Points.

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This week, the Global Polio Eradication Initiative (GPEI) celebrates World Immunization Week (WIW) alongside partners around the world who have worked tirelessly to protect children from vaccine-preventable diseases. Every year, the GPEI vaccinates more than 450 million children against polio in almost 50 countries. These efforts would not be possible without the dedication of vaccine champions – including health workers, parents, government leaders and donors – who are committed to sharing the message that #VaccinesWork for All.

This WIW comes at a difficult time as immunization campaigns – including polio campaigns – are being suspended around the world due to the threat of COVID-19. But, it’s also an important moment to acknowledge the incredible progress we’ve made against polio thanks to our generous donors. (Read more on how the GPEI is responding to the COVID-19 pandemic.)

During this WIW, we are grateful for the longstanding support and dedication of our partners, including His Highness Sheikh Mohamed bin Zayed Al Nahyan, the Crown Prince of Abu Dhabi. At the Reaching the Last Mile Forum in Abu Dhabi in November 2019, global leaders pledged US$2.6 billion to eradicate polio – including His Highness’s pledge of US$160 million, which comes on the heels of pledges dating back a decade. This support has, for example, allowed for the delivery of more than 400 million drops of polio vaccine to protect the most vulnerable and hard-to-reach children in Pakistan and funded more than 5,000 full-time vaccinators in high-risk areas of the country.

Further, through the UAE-Pakistan Assistance Program (UAE PAP), the UAE is helping to build healthy communities and protect against polio through poverty eradication – including by delivering food aid, building water treatment plants and leading infrastructure projects.

While WIW encourages us to celebrate the progress we’ve made and highlight that #VaccinesWork, it also reminds us that continued commitment is key to ending polio once and for all. When the COVID-19 emergency subsides, we will come back stronger and faster in our mission to reach every child with the polio vaccine. These efforts are only made possible by our valued donors. This WIW, we are thankful to UAE leadership for their continued support in our efforts to #EndPolio.

It was a somber day when Ihsanullah was told that two of his youngest children will never be able to walk again. His two year old daughter Safia, and Masood, his five month old son, were both diagnosed with polio.

When they began running a high fever in December, Ihsanullah rushed them to the nearest hospital in the city of Tank, Pakistan. After a series of tests, doctors confirmed that both children had contracted polio. Further investigations revealed that neither child had been vaccinated during any previous routine immunization or polio campaign rounds.

Like many other parents in his village, Ihsanullah had never accepted the polio vaccine. “I had a negative opinion about vaccination from the start. Many people told me that the polio vaccine was made of haram[forbidden] ingredients and was part of a larger conspiracy to make Muslim children sterile,” he said.

A farmer and labourer by profession, 27-year-old Ihsanullah lives in a village named Latti Kallay in Khyber Pakthunkwa, Pakistan. Polio teams often face hesitancy from communities in Latti Kallay during campaign rounds, with many parents citing religion as the primary reason for refusing the polio vaccine. In Tank city and the immediate surrounding areas, six wild polio virus cases were reported in 2019.

Sadly, it sometimes takes a case of polio for communities to fully realize the importance of vaccinating their children. Asghar and Khadim, neighbours of Ihsanullah, told polio teams that they had started ensuring that their children are vaccinated, despite being staunch refusers of the vaccine previously.

Ihsanullah said, “It pains me to imagine that Safia and Masood will never be able to walk again. If I knew that this would be the outcome, I would never have stopped the polio teams from vaccinating my children. I deeply regret my decision, but I will make sure that my other children are vaccinated”.

For now, the COVID-19 pandemic has necessitated the temporary pause of polio vaccination campaigns. This leaves unvaccinated children who cannot access routine immunization services vulnerable to paralysis. The situation also underlines the vital importance of increasing trust in vaccines amongst parents, so their children are protected from polio no matter what happens.

Gohar Mumtaz, the Union Council Polio Officer of the district, has hope. He says that a routine immunization session with the community, conducted before the pandemic spread to Pakistan, seemed to be more popular than usual. “Although there is still hesitancy, the situation seems to be improving. People will understand the need to vaccinate and no child will suffer like Safia and Masood in the future.”

To overcome barriers to polio eradication, the Pakistan polio programme conducted a top-to-bottom review during 2019. Areas where improvement is required were identified, and innovations introduced. This is vital work, as there are many other children in Pakistan besides Safia and Masood whose futures have been marred by the poliovirus. Last year saw increased transmission of the poliovirus across all provinces with a total of 147 wild cases reported.

The COVID-19 pandemic has added an additional hurdle to defeating polio in Pakistan. It is vital that the programme makes up for lost time as soon as it is safe to conduct house-to-house vaccination activities again. Whilst the pandemic is ongoing, the programme continues to build trust with communities by providing information about COVID-19 as well as the poliovirus. Where routine immunization continues in health centres, polio personnel are emphasizing the importance of maintaining children’s vaccination schedules as far as possible.

In a time when our health feels especially precious, Ihsanullah, Safia and Masood’s story serves to remind us why vaccination is so important.

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A female vaccinator stains the finger of a child who has just received a polio vaccine. This photo is illustrative and does not feature the women interviewed for this story. ©WHO

Noora Awakar Mohammad

Noora Awakar Mohammad was only sixteen years old when she started working as a volunteer for the Polio Programme in Somalia. Since then, she has lived through civil war and armed conflict in her country, which have left the health infrastructure in tatters. Recalling the days of war, Noora’s face tenses. “During the civil war years, on many occasions the polio campaign was stopped because of intense fighting. As soon as the fighting would stop, we would run to communities to vaccinate children,” she recalls.

During those days, it was mostly elderly women and mothers who trained as vaccinators. The adolescent Noora had to work hard to build community trust. “Often, I stayed with the community and vaccinated the children amidst war. The community trusted me even though I was a young health worker,” she remembers.

Noora still faces challenges in her fight against polio. Many areas in Somalia are unreachable because of the presence of non-state groups. These groups, who oppose vaccination, have been responsible for creating fear among parents by spreading misinformation. Noora has also encountered vaccine-hesitancy among parents because of inadequate health awareness. “I have seen fathers refusing to vaccinate their children on one hand, while mothers request us to vaccinate them on the other. Under such trying circumstances, we have to seek the help of religious leaders to convince the refusing fathers,” Noora explains.

Alongside polio vaccination, Noora works as a midwife. As part of her role, she educates pregnant women and young mothers about the benefits of vaccination. She also builds awareness of Acute Flaccid Paralysis (AFP) in the community, a key symptom of polio. “I share information about AFP with mothers and now I see more and more mothers bringing their children to health centers even with the slightest symptom of AFP,” Noora says.

Noora emphasizes that closing the current polio outbreak in her country remains tough given the climate of insecurity and inaccessibility, but she remains determined to carry on with her work.

A female health worker monitors the polio vaccination campaign coverage. This photo is illustrative and does not feature the women interviewed for this story. ©WHO

Zainab Abdi Usman

Zainab Abdi Usman is a midwife in Madina district in Banadir state in central Somalia. For the last twenty years, she has volunteered for the polio eradication programme. A source of frustration for Zainab is the children missing out on vaccination in inaccessible areas. The barriers health workers face to access populations in desperate need of basic healthcare and community services are sometimes insurmountable.

“During the civil war, I used to carry the vaccine in a thermos kettle to keep it cold and I would hide it under my Abaya. If fighters got suspicious, they would not allow me to go into the communities to vaccinate the children. Today, many areas remain inaccessible,” Zainab says.

Whenever the access situation changes, the polio programme is amongst the first health initiatives to reach children. Zainab explains, “In a conflict situation, there is an immediate need to treat victims of the conflict. However, at the same time, it is important that we save our children from paralysis resulting from polio. Therefore, reaching out to children in insecure areas is very crucial in our fight against the disease.”

Women check their vaccine supplies during a polio vaccination campaign. This photo is illustrative and does not feature the women interviewed for this story. ©WHO

Feriha Abdur Rehman Yusuf

Feriha Abdur Rehman Yusuf is the young mother of a one-year old boy. She sees the fight against polio as personal and has been part of over 30 immunization campaigns in Somalia.

An incident from Feriha’s past stays with her years later. “One day, during a door-to-door campaign, I knocked at the door of a house. A man carrying a gun opened it. He yelled at me and started shooting in the air. I was shaken for days,” she remembers. Thankfully, the situation has changed in Feriha’s district since then.

Thanks to efforts to educate parents, the public is more aware of the long-term benefits of vaccination. However, Feriha still faces a few families who reject the polio vaccine during campaigns. She tries to convince parents using the examples of her own son, and her nephews and nieces. If families continue to be worried, she seeks help from religious leaders and community members.

Working during campaigns is not easy for Feriha now she has her son. Feriha says that her mother is the biggest supporter of her work and source of encouragement. “When I am in the field during the polio campaigns, my mother practically moves into my house and takes care of my child,” she says.

Feriha believes that despite the climate of insecurity and inaccessibility, things are improving in Somalia. “Health services are getting better than before. More and more children are getting vaccinated, so they have a better shot at life,” she says.

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This story is also available in other languages: French, German, Italian, Japanese, Korean, Portuguese and Spanish

Using the vast infrastructure developed to identify the poliovirus and deliver vaccination campaigns, the polio eradication programme is pitching in to protect the vulnerable from COVID-19, especially in polio-endemic countries. From Pakistan to Nigeria, the programme is drawing on years of experience fighting outbreaks to support governments as they respond to the new virus.

Pakistan

Few health programmes have as much practice tracking virus or reaching out to communities as the Pakistan polio eradication programme. This means the polio team is in a strong position to support the Government of Pakistan in COVID-19 preparedness and response.

Currently, the polio team is providing assistance across the entire country, with a special focus on strengthening surveillance and awareness raising. Working side-by-side with the Government of Pakistan, within three weeks the team has managed to train over 280 surveillance officers in COVID-19 surveillance. It has also supported the development of a new data system that’s fully integrated with existing data management system for polio. All polio surveillance staff are now doubling up and supporting disease surveillance for COVID-19. Through cascade trainings, they have sensitized over 6,260 health professionals on COVID-19, alongside their polio duties, in light of the national emergency. These efforts will continue unabated as the virus continues to spread.

Adding to the capacity of the government and WHO Emergency team, the polio team are also engaged in COVID-19 contact tracing and improving testing in six reference laboratories. They have been trained to support and supplement the current efforts, preparing for a sudden surge in cases and responding to the increase in travelers that need to be traced as a result of the rise in cases. The regional reference laboratory for polio in Islamabad is also providing technical support to COVID-19 testing and has been evolving to cater to the increased demands.

As this is a new disease, polio staff are lending their skills as health risk communicators – providing accurate information and listening to people’s concerns. The government of Pakistan extended a national help line originally used for polio-related calls to now cater to the public’s need for information on COVID-19. The help line was quickly adapted by the polio communication team once the first COVID-19 case was announced. The polio communications team is using strategies routinely used to promote polio vaccines to disseminate information about the COVID-19 virus, including working with Facebook, to ensure accurate information sharing, and airing television adverts. As time goes on, the teams will train more and more people ensuring the provision of positive health practices messages that can curb the transmission of the virus.

Afghanistan

Currently, community volunteers who work for the polio programme to report children with acute flaccid paralysis (AFP) are delivering messages on handwashing to reduce spread of COVID-19, in addition to polio. UNICEF is similarly using its Immunization Communication Network to disseminate information on personal hygiene.

Field staff have taken the initiative of using their routine visits to health facilities, during which they check for children with AFP, to check for and report people who may have COVID-19. Meanwhile, programme staff are building the capacity of health workers to respond to the novel coronavirus.

To coordinate approaches, the WHO Afghanistan polio team has a designated focal point connecting with the wider COVID-19 operation led by the Government of Afghanistan. The polio eradication teams at regional and provincial levels are working closely with the Ministry of Public Health, non-governmental organizations delivering Afghanistan’s Basic Package of Health Services and other partners to enhance Afghanistan’s preparedness.

Nigeria

“In the field, when there is an emergency, WHO’s first call for support to the state governments is the polio personnel,” says Fiona Braka, WHO polio team lead in Nigeria.

In Ogun and Lagos states, where two cases of COVID-19 have been detected, over 50 WHO polio programme medical staff are working flat out to mitigate further spread, using lessons learnt from their years battling the poliovirus. Staff are engaged in integrated disease surveillance, contact tracing, and data collection and analysis. Public health experts working for the Stop Transmission of Polio programme, supported by the US Centers for Disease Control and Prevention, are using their skills to undertake COVID-19 case investigations.

The WHO Field Offices -which are usually used for polio eradication coordination- are doubling up as coordination hubs for WHO teams supporting the COVID-19 response. The programme is also lending phones, vehicles and administrative support to the COVID-19 effort.

In states where no cases of COVID-19 have been reported, polio staff are supporting preparedness activities. At a local level, polio programme infrastructure is being used to strengthen disease surveillance. Polio staff are working closely with government counterparts and facilitating capacity building on COVID-19 response protocols and are working to build awareness of the virus in the community. Specials efforts are being undertaken to train frontline workers as they are at high risk of contagion.

Beyond polio-endemic countries

Trained specialists in the STOP program, part of the Global Polio Eradication Initiative, are actively supporting preparations or response to COVID-19 in 13 countries worldwide. The WHO Regional Office for Africa’s Rapid Response Team, who usually respond to polio outbreaks, are aiding COVID-19 preparedness in countries including Angola, Cameroon and the Central African Republic. Meanwhile, polio staff in other offices are ready to lend support, or are already lending support, to colleagues working to mitigate and respond to the new virus.

In our work to end polio, the programme sees the devastating impact that communicable diseases have. With this in mind, we are fully committed to supporting national health systems by engaging our expertise and assets to help mitigate and contain the COVID-19 pandemic, alongside continuing concerted efforts to eradicate polio.

For the latest information and advice on the COVID-19 disease outbreak visit the WHO website.

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Thousands of women work in the Pakistan polio eradication programme as scientists of many specialties, managers, data experts, vaccinators, front-line team supervisors and social mobilizers. We asked a few of them about gender equality in their work.

Dr. Maryam Mallick supports equality everywhere. ©WHO Pakistan/Sadaf Kashif

Dr. Maryam Mallick: The Medical Rehabilitation Specialist

“Women face extra difficulties in trying to prove themselves and often compete in an outnumbered male dominated work environment. But with the right support, they persevere and excel in their tasks.”

Dr. Maryam Mallick is one of the first female technical advisors for disability and rehabilitation at the World Health Organization in Pakistan. Her job involves assessing children with polio paralysis to ensure that they receive medical and social rehabilitation care.

Dr. Mallick works to ensure that all children, especially girls, are given access to quality healthcare as well as equal opportunities in society.

“There were many instances where parents did not want their polio affected daughters to be sent to the schools. We need to start perceiving gender equality as a fundamental human right inherently linked to sustainable development, rather than just a women’s issue,” she says.

“Women’s empowerment in achieving sustainable development has now been globally recognized as the centrality of gender equality. It does not mean that men and women become the same, rather it means that everyone can have equal rights and equal opportunities”

Under Dr. Mallick’s supervision, one thousand children have been assisted by the Polio Rehabilitation Initiative since 2007.

Dr. Iman Gohar: The first female Provincial Rapid Response Unit Lead in Sindh province

Dr. Iman Gohar strikes the #EachforEqual pose, used to promote gender equality. ©WHO Pakistan/Dawood Batozi

“Many women in the programme have enormous talent and endless potential. These women are key to enabling success across the polio eradication effort.”

Dr. Iman Gohar joined the Pakistan polio eradication programme six years ago, working as a Polio Eradication Officer in Peshawar and then as the Divisional Surveillance Officer in Hyderabad. Today, Dr. Gohar is the first woman to lead the Provincial Rapid Response Unit in Sindh.

Dr. Gohar’s work involves leading investigations into suspected polio cases and organising case response campaigns. An increased number of environmental samples found positive for the poliovirus in Sindh in the 2019-2020 period has meant a busy workload.

“Polio eradication is an incredibly demanding job. I work for long hours and enjoy one day off in the week. While performing my job, I work hard to take complex goals and convert them into high quality deliverables,” she says.

“The programme has provided women with a very conducive environment to grow, learn and voice their opinion. For this, I am very grateful.”

When talking about how the programme can improve gender equality, Dr. Gohar stressed the role and support of her male colleagues.

“I believe for us to achieve true gender equality, it is essential that our male co-workers become advocates for equality. Men and women must both hold each other up, celebrate each other’s successes and recognize that each and every person, regardless of gender, is playing an important role in safeguarding the health of Pakistan’s children.”

Making the sign for #EachforEqual. ©WHO Pakistan/Saima Gull

Salma Bibi: A Health Worker in Killa Abdulla district, Balochistan province

“Nothing gives me greater satisfaction than knowing how I have helped people through my duties. I believe that creating opportunities for women is one of the best ways to empower them.”

Salma has been a community health worker for over a decade, working in Killa Abdullah district in Balochistan province. Around 90% of the district is overseen by male health workers, so Salma is one of the few women who go door to door to ensure that children are vaccinated.

Salma often feels greater resistance from community members than her male counterparts. “I hear a lot of negative comments from community members, especially when covering vaccine hesitant families. These words can sometimes de-motivate and de-moralize us from our duties,” she says.

Despite this challenging environment, Salma recognizes that her role is integral to get parents to understand the importance of vaccination.

“When our male colleagues cannot enter the homes, we play an important role in filling that gap. We go in and we sit with the mothers to help them understand that vaccinating against polio is the only way to protect their children. Often, the time spent talking to them is enough, and this makes us feel good, like we are truly helping our nation’s children.”

Saba Irshad: The first female Programme Data Assistant in Multan district, Punjab province

Committed to gender equality. ©WHO Pakistan/Saima Gull

“The greatest challenge that the majority of the professional women face is the perception that they are not as qualified or competent as their male colleagues, irrespective of their experience, education, potential or achievements. Because of this, women often have to work twice as hard.”

Saba Irshad has worked with the Pakistan polio eradication programme for eight years. She is known by her colleagues for her quick problem-solving skills and meticulous work. As a Programme Data Assistant, Saba is responsible for collecting and analyzing data from campaigns implemented in Multan district, in Punjab province.

Saba emphasizes the need for the polio programme to continue to support and encourage their female workforce, and promote an inclusive work environment.

“On average, 62% of the vaccinator workforce in Pakistan are women. This shows just how important women are to polio eradication.”

“Without these women, the programme would be unable to reach thousands of children with the vaccine.”

To learn what the Global Polio Eradication Initiative is doing to promote gender equality, visit the gender section of our website.

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In January:

No cases of wild poliovirus were reported
9.9 million children were vaccinated.
Permanent transit teams vaccinated 1,743,299 children and cross-border teams vaccinated 117, 232 children

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United Nations Secretary-General António Guterres vaccinated a child at a school in Lahore during the February nationwide polio campaign. ©Syed Mehdi Bukhari

The Secretary-General of the United Nations (UNSG) António Guterres yesterday visited a kindergarten school in Lahore during the first nationwide polio campaign of the year and vaccinated students with the polio vaccine. More than 39 million children across the country are set to be vaccinated during the February campaign.

The UNSG commented on the polio eradication efforts of the country, saying that, “Polio is one of the few diseases we can eradicate in the world in the next few years. This is a priority of the United Nations and I am extremely happy to see it is a clear priority for the Government of Pakistan.”

“My appeal to all leaders, religious leaders, community leaders, is to fully support the Government of Pakistan and other governments around the world to make sure that we will be able to fully eradicate polio.”

As part of his visit, Secretary-General Guterres met with frontline workers of the Pakistan Polio Eradication Programme and expressed his deep solidarity. There are currently 265,000 frontline workers who go door to door during campaigns to ensure that as many children as possible are vaccinated against polio. Almost 62% of these workers are female. Women are key to helping the programme rally community members, parents and caregivers in support of polio eradication.

Dr. Yasmin Rashid, the Health Minister for Punjab, welcomed Secretary-General Guterres to the school. Dr. Rashid briefed the UN mission on Pakistan’s progress in polio eradication, the remaining challenges faced by the country, and strategies being currently implemented to interrupt virus transmission. She further praised the efforts of the United Nations in assisting Pakistan to achieve a polio-free status.

Secretary-General Guterres expressed deep solidarity with the health workers who are on the frontlines of polio eradication efforts. ©Syed Mehdi Bukhari

“The Government of Pakistan thanks the United Nations for their support and commitment to end Pakistan’s battle against polio. We are committed to working as ‘one team under one roof’ and believe together, we can make Pakistan polio-free,” Dr. Yasmin Rashid said.

In 2019, Pakistan was confronted with a resurgence of polio beyond traditional strongholds of the virus. Wild poliovirus cases increased from 12 in 2018 to 144 by the end of 2019. There are 17 cases thus far in 2020. Secretary-General Guterres’ visit comes at a time when the Pakistan Polio Eradication Programme is re-thinking its operations to better respond to increased virus transmission.

WHO Pakistan Representative Dr Palitha Malipala emphasized the importance of incorporating high level commitment to polio eradication from across the political strata.

“Polio eradication remains a top priority for WHO and the global polio partnership. We will continue to support the Government of Pakistan, who spearhead this initiative in country, to overcome the challenges of the last year and put in place robust measures to ensure a polio-free world for future generations,” he said.

There is a long-standing relationship between the Global Polio Eradication Initiative and the Office of the UN Secretary-General. Two previous UNSGs – Kofi Annan and Ban Ki-Moon – were both strong advocates of global polio eradication as an important goal of the UN system. Secretary-General Guterres’ visit continues this collaboration and emphasizes his personal oversight and commitment to a polio-free world.

Pakistan and Afghanistan are the only countries worldwide where wild poliovirus is still endemic. The concerted commitment to improving operations shown by both countries will be key to eradicating the virus.

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A vaccine is administered to a child during a polio immunization campaign. ©WHO/AFRO

From a small prefabricated container where the walls host detailed maps and desks prop up computer screens beaming data, tables and graphics, the Rapid Response Team at the World Health Organization’s (WHO) Regional Office for Africa coordinate polio outbreak response. The team work across the continent, where 12 countries are battling the vaccine-derived strain of the virus.

Dr Ndoutabe Modjirom, a former Chadian university professor-turned WHO medical officer, coordinates the multi-agency team, which was formed in September 2019. It is composed of twenty experts in operations and vaccination management, epidemiology, logistics, and communications. They are drawn from the core partners of the Global Polio Eradication Initiative (GPEI): WHO, the United Nations Children’s Fund (UNICEF), Rotary International, the US Centers for Disease Control and Prevention, the Bill & Melinda Gates Foundation, and Gavi, The Vaccine Alliance.

The team is mobilized whenever a new polio outbreak is confirmed in the African region.

The first 72 hours

“Our work 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 after the lab confirmation means that the poliovirus is circulating and risks infecting more children,” says Dr Modjirom.

Within the first 72 hours, the Rapid Response Team deploys Team A. This team includes the GPEI Coordinator alongside an epidemiologist, an operations officer, a vaccine manager and a communicator for development. The team works closely with the health authorities in the affected country along with the relevant WHO and UNICEF country offices to prepare a risk assessment and outbreak response plan. The emergency response vaccination campaign, called ‘Round Zero’, starts within 14 days.

Team B takes over from Team A after the first eight weeks and continues the outbreak response activities.

According to standard operating procedures for responding to outbreaks, the polio programme must implement three rounds of high-quality vaccination campaigns in response to every outbreak. Parallel to vaccination, countries must intensify disease surveillance activities to detect new cases of acute flaccid paralysis, a clinical symptom of poliomyelitis.

“Priorities are constantly shifting for the Rapid Response Team,” says Dr Christopher Kamugisha, who has been working with WHO since 1998. He has been a member of the Rapid Response Team since its inception and like the rest of the team has been chasing new polio outbreaks across the region.

“In August I was in Somali Region in Ethiopia supporting the outbreak response, conducting the first vaccination campaign round. On the second day of the campaign, Dr Ndoutabe informed me that a new case was detected in Cheporoni in Ghana and asked me to go and provide technical support,” Dr Kamugisha recalls.

The Rapid Response Team discuss their next deployments. ©WHO/AFRO — The Rapid Response Team gathers to discuss their next deployments. ©WHO/AFRO

Within 24 hours, he was on a plane to Accra through Addis.

“I arrived at noon the next day and went straight to support the national technical team in their preparations and risk assessment. I assisted with ensuring that their plans are in line with the international standard operating procedures set by the GPEI,” Dr Kamugisha says.

No cure for polio

Polio is a viral disease, multiplying in the intestines and transmitted from person to person mainly through a faecal-oral route or, less frequently, through contaminated water or food.

While there is no cure for polio, the disease can be prevented through administration of a simple and effective vaccine. That is why efforts are underway across the country to rapidly boost immunity levels in children and protect them from polio paralysis.

Thanks to the efforts of the GPEI and country governments, 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.

In 2020, the central challenge for the African Region is overcoming outbreaks of circulating vaccine derived poliovirus. Vaccine-derived polioviruses are rare, but can affect unimmunized and under-immunized populations living in areas with inadequate sanitation and low levels of polio immunization.

Countries 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. Reasons these outbreaks have occurred include weak routine vaccination systems, vaccine hesitancy, difficulty accessing some locations and low-quality vaccination campaigns, which have made immunization of all children challenging.

In addition to the response activities, the Rapid Response Team work to build the capacity of health workers and decision makers in countries that are not experiencing polio outbreaks, training them to be ready to respond if virus is ever detected.

The team also aims to recruit more women with expertise in outbreak response. Achieving gender balance amongst personnel through a more equitable recruitment process forms part of the GPEI Gender Equality Strategy 2019 – 2023, which was launched in May 2019.

By supporting countries during outbreaks, and building health system resilience in vulnerable settings, the polio programme is working to establish a sustainable legacy that will improve health long after global eradication of the virus.