A child in west Africa receives polio vaccine. Photo: WHO.

More than 190 000 polio vaccinators in 13 countries across west and central Africa will immunize over 116 million children over the next week, to tackle the last remaining stronghold of polio on the continent.

The synchronized vaccination campaign, one of the largest of its kind ever implemented in Africa, is part of urgent measures to permanently stop polio on the continent.  All children under five years of age in the 13 countries – Benin, Cameroon, Central African Republic, Chad, Côte d’Ivoire, Democratic Republic of Congo, Guinea, Liberia, Mali, Mauritania, Niger, Nigeria and Sierra Leone – will be simultaneously immunized in a coordinated effort to raise childhood immunity to polio across the continent. In August 2016, four children were paralysed by the disease in security-compromised areas in Borno state, north-eastern Nigeria, widely considered to be the only place on the continent where the virus maintains its grip.

“Twenty years ago, Nelson Mandela launched the pan-African ‘Kick Polio Out of Africa’ campaign,” said Dr Matshidiso Moeti, WHO Regional Director for Africa.  “At that time, every single country on the continent was endemic to polio, and every year, more than 75 000 children were paralysed for life by this terrible disease.  Thanks to the dedication of governments, communities, parents and health workers, this disease is now beaten back to this final reservoir.”

Dr Moeti cautioned, however, that progress was fragile, given the epidemic-prone nature of the virus.  Although confined to a comparatively small region of the continent, experts warned that the virus could easily spread to under-protected areas of neighbouring countries. That is why regional public health ministers from five Lake Chad Basin countries – Cameroon, Central African Republic, Chad, Niger and Nigeria – declared the outbreak a regional public health emergency and have committed to multiple synchronized immunization campaigns.

UNICEF Regional Director for West and Central Africa, Ms Marie-Pierre Poirier, stated that with the strong commitment of Africa’s leaders, there was confidence that this last remaining polio reservoir could be wiped out, hereby protecting all future generations of African children from the crippling effects of this disease once and for all. “Polio eradication will be an unparalleled victory, which will not only save all future generations of children from the grip of a disease that is entirely preventable – but will show the world what Africa can do when it unites behind a common goal.”

To stop the potentially dangerous spread of the disease as soon as possible, volunteers will deliver bivalent oral polio vaccine (bOPV) to every house across all cities, towns and villages of the 13 countries.  To succeed, this army of volunteers and health workers will work up to 12 hours per day, travelling on foot or bicycle, in often stifling humidity and temperatures in excess of 40°C.  Each vaccination team will carry the vaccine in special carrier bags, filled with ice packs to ensure the vaccine remains below the required 8°C.

“This extraordinary coordinated response is precisely what is needed to stop this polio outbreak,” said Michael K McGovern, Chair of Rotary’s International PolioPlus Committee .  “Every aspect of civil society in these African countries is coming together, every community, every parent and every community leader, to achieve one common goal: to protect their children from life-long paralysis caused by this deadly disease.”

The full engagement of political and community leaders at every level – right down to the district – is considered critical to the success of the campaign.  It is only through the full participation of this leadership that all sectors of civil society are mobilized to ensure every child is reached.

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Kobra Ibrahim, 22, a monitor for the polio campaign poses for a picture during the polio vaccination campaign in Mazar on October 22, 2016. Photo: WHO Afghanistan/Rada Akbar

Thousands of remarkable female vaccinators, supervisors, campaign coordinators, surveillance volunteers and social mobilizers play a critical role in Afghanistan’s efforts to eradicate polio. The progress the polio programme has witnessed in the past years would not have been possible without the hard work and commitment of courageous women who are dedicated to protecting children and making polio history.

Through this series of photographs, meet some of the brave and hard-working Afghan women who are leading the battle against this paralyzing disease, bringing Afghanistan, and the world, closer to eradicating polio for good.

More than 65,000 dedicated frontline workers are working tirelessly to eradicate polio from Afghanistan

Feroza and over 65,000 dedicated frontline workers are at the heart of efforts to eradicate polio from Afghanistan.

Feroza is one of the more than 65,000 dedicated frontline workers who are working tirelessly to eradicate polio from Afghanistan. For the past year, she has been working as a volunteer polio vaccinator, vaccinating children in her community during immunization campaigns.

“Polio is a very dangerous disease and people often underestimate how important and effective the vaccine is in preventing the irreversible consequences of the disease,” Feroza says. “I joined the polio programme because I want to raise awareness about the polio vaccine and its benefits to children in my community.”

Most of Afghanistan remains polio-free with the circulation of the virus confined to small areas in the southern, eastern and south-eastern parts of the country. In 2016, 12 wild poliovirus cases were reported, down from the 20 cases reported in 2015 and 28 in 2014. One case has been reported this year.

A number of new developments were implemented in 2016 to accelerate progress towards stopping polio transmission. This included the training of all polio field workers with a new curriculum to boost their skills and ensuring that frontline workers are kept motivated and committed.

Dedicated and brave vaccinators like Feroza are at the heart of the polio eradication effort. Female polio workers are particularly important in building trust in their communities and encouraging vaccination, ensuring more children are reached with life-saving vaccines.

“The best thing about my work is helping women and children and spreading awareness about the problems that are caused if children are not vaccinated. Sometimes mothers try to convince us to give them the vaccine as well since we are praising it so much – this is always amusing,” says Feroza smiling.

During vaccination campaigns, Feroza and her team visit houses to vaccinate all children under the age of 5 with the oral polio vaccine (OPV). “We work long and hectic days during the campaigns but I enjoy it.”

The work of volunteers like Feroza is crucial to reducing the number of children missed during immunization campaigns.

Afghanistan has a well-informed generation of parents who accept the polio vaccine every time it is offered to them. According to a study carried out in 2016, nearly 90% of Afghans recognize that vaccination is a way of preventing polio and there has been a reduction in the belief in preventing polio by using traditional medicine.

“We generally don’t face any problems during campaigns as most families are familiar with the vaccine and want to vaccinate their children. If families are hesitant, we try to encourage them by giving them information about the benefits of the vaccine. If they still reject the vaccine, we ask our supervisors to come and help convince them. I have never met a family who refused the vaccine in the end,” Feroza says.

Vaccination_Nigeria
A health worker prepares to administer a vaccine in northern Nigeria. WHO/L.Dore

A mass vaccination campaign to protect more than 4 million children from a measles outbreak in conflict-affected states in north-eastern Nigeria started on 13 January. The polio eradication infrastructure has been on hand to help with this feat of logistics. GPEI partners WHO, UNICEF and US Centres for Disease Control have been working with nongovernmental organizations to support the campaign in a range of areas including data management, training, social mobilization, monitoring and evaluation, supportive supervision and waste management.

“Nigeria’s well-established polio vaccination programme provides a strong underpinning for the campaign,” says Dr Wondimagegnehu Alemu, WHO Representative in Nigeria. “Population data from the polio programme has been essential to guide planning for the measles campaign. We are also able to make use of staff that have vast experience in providing health services in very difficult and risky areas.”

One third of more than 700 health facilities in Borno State, north-eastern Nigeria, have been completely destroyed, according to a report released in December by WHO. Of those facilities remaining, one third are not functioning at all. This is leaving the health of communities vulnerable.

WHO has a strong presence in the community in these areas thanks to a well-established polio programme which includes teams of health workers trained to work in areas of high insecurity and reach communities that no other partner can reach.

With levels of malnutrition as high as 20% in some populations in Borno State, children are particularly vulnerable to diseases like measles, malaria, respiratory infections and diarrhoea.

Planning for the future

This measles campaign in northern Nigeria is by no means the only example of polio funded functions and infrastructure contributing to other critical functions. On average, polio-funded staff spend more than 50% of their time on non-polio activities, such as routine immunization, measles campaigns, maternal and child health initiatives, humanitarian emergencies and disease outbreak, sanitation and hygiene programmes and strengthening health systems. In Nigeria in 2015, the Emergency Operations Centres set up to tackle polio were repurposed instantly in response to the spread of Ebola to the country, which enabled the outbreak to be ended almost as soon as it began.

Polio is closer to eradication than it has ever been; and while we keep all efforts on rooting out the virus in its final hiding places, the Global Polio Eradication Initiative is also beginning to plan for the future.  The 16 priority countries, including Nigeria, where 95% of the programmes assets are based are planning now so that some polio funded functions and infrastructure can continue to contribute to other critical health and development goals, as polio funding gradually decreases

Read more about the measles vaccination campaign in Nigeria.

Children in a polio free India
Children in a polio free India. Photo: GPEI

Six years ago today, Rukhsar Khatoon from West Bengal became the last Indian child to be paralyzed by polio. Since that day, India has not experienced a single case of wild polio, paving the way for the South East Asia Region of the World Health Organization to be certified polio-free in 2014.

Once considered the toughest context in the world to eradicate polio, India achieved this feat through a relentless focus on reaching and immunizing every last child: it has since maintained high immunity to polio and very high quality disease surveillance, made the switch from trivalent to bivalent oral polio vaccine in its routine immunization system, and is working to transition its extensive polio eradication knowledge and assets to serve broader public health goals.

Sensitive disease surveillance and high immunity against polio remain important priorities for all countries until the remaining endemic countries stop polio for good.