A nation-wide immunization campaign helped in eradicating polio in India. WHO/2011
Eradicating polio in India was a feat of dedication, commitment and simply doubling down on immunization activities. Given India’s vast population, tropical climate in many parts of the country, and other environmental challenges, it would be easy to imagine that if polio couldn’t be stopped, India would be the place to fail.
Simply put: it was a challenge. After all, India constituted over 60% of all global polio cases as recently as 2009.
However, in 2014, India was officially declared polio-free, along with the rest of the South-East Asia Region. Thanks to the singular commitment of the Indian Government at all levels, partners of the Global Polio Eradication Initiative, notably WHO, Rotary International and UNICEF, polio was tackled head-on. India has not had a case single case of wild polio virus since 2011.
India had long been considered one of the most difficult geographical locations to eliminate the disease. Success in India really changed the game, and now serves as an example that eradication of polio is indeed possible when the world marshals political will and commits adequate resources to the cause that affects everybody worldwide.
Today, the world is close to making public health history when it comes to polio – as it was when in 1980 small pox was officially eradicated. The goal of reaching a polio-free world is well within reach.
Tune in to listen to the podcast as the UN Dispatch tells the story of how, against all odds, India wiped out polio, and some of the lessons learned along the way.
Gafo is the first case of polio in Papua New Guinea in almost two decades. WHO PNG/J.Rivaca
For six-year old Gafo that fateful April 2018 morning was supposed to be the start of just another day full of running around and playing with friends. Ignoring the pain in his legs, Gafo tried to get out of bed, but he fell and struggled to get back up. Over the course of the next two days, Gafo’s condition continued to deteriorate. On the third day, Gafo and his family visited the Angau Memorial General Hospital in Lae, Morobe, in the central northern coast of Papua New Guinea, only to find out that he had polio.
As soon as Gafo’s story broke, a National Emergency was declared by the Government and a mass polio vaccination campaign was initiated. Gafo became the foremost champion of polio awareness, and served as a cautionary tale for families and young children to get vaccinated.
Since his diagnosis, Gafo has made progress. Though he can now walk with his signature gait, Gafo and his parents understand that polio is irreversible, but is preventable and eradicable. Gafo hopes to become a doctor one day. Read about his entire journey from being an ordinary child to breaking news, and how his story has helped contain polio in Papua New Guinea.
This story is originally from the Papua New Guinea Polio Outbreak Response First 100 Days report.
Pakistan’s routine immunization programme Expanded Programme on Immunization will carry out a nationwide measles vaccination campaign targeting around 31.8 million children aged 9-59 months from 15 to 27 October to respond to an ongoing measles outbreak in Pakistan. Over 30 000 measles cases have been reported this year, compared with around 24 000 cases in 2017.
Pakistan typically encounters a measles outbreak every 8 to 10 years, and the Federal Ministry of Health works proactively to stop these outbreaks with regular vaccination campaigns. Although the Polio Eradication Initiative and the Expanded Programme on Immunization are separate entities, they work together to improve immunization outcomes in Pakistan. Achieving strong essential immunization coverage is a critical step in bringing Pakistan closer to ending polio, and once this goal is reached, in maintaining polio-free status.
Many of the areas at highest risk for polio are also at high risk for measles. During the upcoming measles campaign, the polio programme will lend its human, physical and operational resources, knowledge and expertise to achieve the highest possible measles immunization coverage across the country.
Reaching more children through stronger collaboration
The collaboration between polio and routine immunization programmes has made a significant difference in vaccination efforts across dense urban environments as well as scattered rural settings. A key factor for success has been the polio programme’s highly-skilled workforce of community vaccinators, front-line health workers and social mobilizers.
During every round of country-wide polio vaccination campaigns, around 260 000 front-line health workers vaccinate more than 38 million children under the age of 5 across Pakistan. With vital on-the-ground experience in some of the most challenging settings, they are determined to ensure that the lessons learned in polio are transferred to other health interventions.
“Our front-line workers have built strong rapport in their respective communities,” said Dr. Rana Safdar, coordinator of the National Emergency Operation Centre (NEOC) for polio eradication and member of the National Measles Steering Committee.
“They understand the dynamics of the population, even as they relate to children, not only at the district level but also at the Union Council and village level. This indigenous knowledge coupled with community trust can definitely play an instrumental role for other health interventions.”
Unlike polio eradication activities, measles immunization is not carried out from door-to-door but at fixed centres at health facilities as well as through outreach sessions within communities. Children are mobilized to the vaccination sites where trained healthcare professionals administer the injectable measles vaccine. The deep local knowledge polio workers have developed and the trust they have built with their communities is vital in mobilizing caregivers to take their children for measles immunizations at nearby vaccination sites.
“The strong collaboration between the two programmes has helped us vaccinate more children. Our joint efforts are geared towards reaching every last child and they have shown significant progress so far. We hope that our synergized efforts during the upcoming measles campaign will lead us to reach every child in the target population with measles vaccine,” said Dr. Tahir Abbas Malik, from the Pakistan polio programme.
“For polio, these coordinated efforts have paved the way for increasing the coverage of persistently missed children, especially those who are on the move or reside in hard-to-reach areas. Similarly, integrated micro planning, monitoring and reporting of children who have not received essential immunization have been instrumental for achieving gains for routine immunization through enhanced coverage,” said Dr. Tahir Abbas Malik.
Pakistan polio eradication programme has achieved significant progress in recent years, thanks to renewed government commitment and revitalized community ownership. However, in cities like Karachi, poliovirus continues to be detected.
Working to overcome the virus once and for all, the polio programme an emergency action plan in January 2018. Since then, the geographical scope of the virus has been noticeably reduced. Much of this progress is thanks to religious leaders like Imam Qari Mehboob, who has spent years building trust and demand for polio vaccination in some of the most difficult areas of the city.
Gulshan-e-Buner is in the eastern corner of Karachi. The town includes some of the most impoverished and high-risk populations of the city. Playing in the streets, playgrounds and compounds that wind up and down the hilly landscape are around 2200 boys and girls under five years old. The places where they learn to crawl, walk, and run are perfect hiding spots for the paralysing poliovirus, but the last detection in the environment was in June 2016. No child in Gulshan-e-Buner has been paralysed by polio since 2014. In a community where vaccine refusal has sometimes caused problems, this represents a dramatic transformation.
Gulshan-e-Buner is one of the high-risk areas of Karachi where the polio programme first began community-based vaccination. Religious leaders helped to identify and recruit female vaccinators to reach every child with vaccines, and the area seemed well on the way to becoming polio-free. Then in 2012, an attack on health workers caused vaccination activities here to stop. In the years since, the commitment of religious leaders to ensure security, restore access, and build community trust has been crucial to defeat the virus.
Iman Qari Mehboob is 50 years old, a migrant from Khyber Pakhtunkhwa like most of his neighbours. He calls the community to prayer five times a day, and teaches many of the youngest children in the town. A father of four children, he is devoted to keeping them and all the other children in his community safe from the poliovirus. His support of the polio programme has helped increase vaccine trust, boost uptake of routine immunization services, and spark conversations about the vaccine.
During every polio vaccination campaign, Qari Mehboob goes from house to house with vaccination teams to check for any unvaccinated children. He speaks to parents who refuse the vaccine for their child, reassuring them that it is safe and effective. He conducts his work under the guidance of the National Islamic Advisory Group for Polio Eradication (NIAG), which educates religious leaders about polio eradication and the unique and important role they can play in protecting all Pakistan’s children from polio.
Under the guidance of NIAG, religious leaders are trained on the basics of social mobilization, communication, health, and hygiene. They also learn about the religious justifications for polio vaccination, including examining the arguments and fatwas of influential religious scholars.
Reflecting on his training, Qari Mehboob says, “The toughest job [for the NIAG trainers] is to convince religious clerics because their denial and doubt is deep rooted, but the collective Fatwa [scholarly verdict] of prominent scholars helps a lot”.
Since his training, Qari Mehboob has organised community engagement sessions to raise awareness about the dangers of the poliovirus. He often makes vaccination a central theme during his sermons at Friday and Eid prayers.
“I face less resistance because most of the people here know me personally and they rely on me because of my status as a religious cleric.” he says.
Qari Mehboob also uses the power and platform of his mosque to amplify his voice. He means this literally – sometimes he can be found using a loudspeaker. That’s so that mothers working inside compounds and homes can hear his messages, as well as the fathers who attend prayers. He doesn’t just speak about polio eradication, but also educates his community about personal hygiene, routine immunization and importance of education in Islam.
To thank him for his work, the provincial polio eradication programme team gave Qari Mehboob a clock during a Mosque promotional activity a few years ago. Below the time lies a message emphasising the importance of vaccination. Now displayed prominently on the wall of the mosque, the gift reminds parents why the polio vaccine is one of the best gifts that they can give to their children.
Back out in the streets of his town, Qari Mehboob laughs with local children as he checks their finger marking to make sure that they are vaccinated.
Discussing his motivation, he says, “These children are my own children. So I must protect them from any harmful disease - especially from a crippling disease like polio.”
At the end of the day’s campaign, Qari Mehboob offers tea and cookies to members of the provincial polio eradication programme team.
Since he joined the programme, vaccine refusals in Gulshan-e-Buner have dropped by 50%, and far more children receive their full polio vaccine doses on time.
Reflecting on the impact of his work, Qari Mehboob returns to his desire to keep all children safe. “I feel an extreme level of contentment after I contribute my part in the programme,” he says.
In the Democratic Republic of the Congo, emergency response has been ongoing since 2017 to overcome outbreaks of circulating vaccine-derived poliovirus, caused by low rates of routine immunization. In the battle to close the outbreak, health workers, partners of the Global Polio Eradication Initiative, Governors of affected provinces, and the Ministry of Health are working together to vaccinate every child. In a context with weak health systems and other high-profile health and humanitarian emergencies, these united efforts are crucial to boost population health and keep all young children safe from paralysis.
In Tanganyika province, where poliovirus was first detected in September 2017, outbreak response is focused on reaching all vulnerable populations with the safe, effective oral polio vaccine. Health infrastructure is weak in the province, and it has taken concerted efforts to reach many children. Here, mothers with their babies queue for polio immunization activities in Manono district, organized with the support of WHO, UNICEF and partners.
Despite several campaigns, immunity gaps still remain. Continuing cases from several virus strains in the country show that the battle to protect every child from paralysis is far from over. Here, a nurse carefully places vaccines vials back in a cooler during immunization activities in Manono. It is critical that the polio vaccine is kept cool, a considerable challenge in warm locations far from the nearest vaccine storage facility.
A small boy is vaccinated against polio after waiting in line with his mother. The Democratic Republic of the Congo has some of the lowest vaccination rates worldwide, and it is hoped that the lessons learned in overcoming this and other health emergencies will help strengthen the country’s health system for the future, and prevent other outbreaks.
A community mobilizer tells a woman in a village in Manono about the polio vaccination campaign that has just begun. Community mobilizers, usually local people trained by UNICEF and partners, are a critical part of efforts to ensure that every child is protected from the virus. Going house to house, they speak to parents about the dangerous poliovirus, and answer questions about the vaccine. Often, they also provide other health service support, including child and maternal health advice.
A girl has her little finger marked after being vaccinated against polio. All children under the age of five are being targeted in vaccination campaigns in the affected districts.
Amongst the communities here, there are children whom the virus has already reached. Remy Muyombi was previously an opponent of vaccination. Since his three-year-old son Justin was affected by polio paralysis, he has become a strong advocate of the campaigns ongoing in his district. So far in 2018, there have been eleven confirmed cases of polio paralysis due to the outbreak. In 2017, 22 children were paralyzed.
A community health worker crosses a shallow stream with his bike to reach the most distant children in Manono health zone. Many communities here live hours from the nearest road, far from any route that a car could easily traverse.
After a household is visited with vaccines, health workers mark the home with chalk to show that the children there have been immunized. They also collect paper records of vaccination, to feed back into a central monitoring and evaluation system coordinated by WHO.
Community mobilizers speak to a mother in Kalunga site for internally displaced people in Tanganyika Province. Regular movement of people in the Democratic Republic of the Congo complicates outbreak response, as there is a real threat of virus spread. The programme works specifically with moving and displaced populations to boost immunization rates, and collaborates with other UN agencies to gather up-to-date information on population movements and the wider humanitarian situation in the country.
A girl is vaccinated against polio in Manono. With each campaign, the polio eradication programme is looking to protect more children, and get closer to ending the outbreak. More polio immunization activities are planned for the coming months, building on commitment from the government of the Democratic Republic of the Congo and provincial governors. Working with other programmes, and in complex contexts, the polio eradication teams continue their work to keep every child safe from polio paralysis.
Children clutch parents as the crowds gather. Overhead, clouds fill the sky, whilst below, noise rolls around the square where people stand. Shouts, music, and laughs all contribute to a growing sense of occasion.
The excitement lies at the heart of Karachi, Pakistan’s largest metropolis. Mazar-e-Quaid, the mausoleum of Pakistan’s founding father Muhammad Ali Jinnah, is a prominent symbol of Pakistani independence, and of the united people of Pakistan.
Each year, millions of people from across Pakistan and the world visit Mazar-e-Quaid. The number of visitors reaches its peak on 14 August, Pakistan’s Independence Day. As the sun rises, thousands arrive dressed in green, the national colour, carrying food and flags, ready to be first to enter once the site is opened up to the public.
For the Pakistan polio eradication programme, Independence Day is an important opportunity. From morning to night, they will take part in a herculean effort to vaccinate all children visiting the mausoleum against the poliovirus. In doing so, they are setting world records for the number of children vaccinated in one location.
Permanent Transit Points (PTPs) are vaccination sites established at important transit points such as country and district borders, bus terminals and railway stations, to make sure that children on the move are vaccinated against polio. Currently, there are 390 PTPs across Pakistan.
On an ordinary day, eight vaccinators work at a PTP at Mazar-e-Quaid. After a quick brief, they are ready to protect all visiting children from the virus with just two drops of the safe, effective oral polio vaccine.
Independence Day requires a different kind of operation. The teams know that they have to take the opportunity to vaccine young children who otherwise might miss out.
Twenty vaccinators volunteer, enthusiastic to meet the influx of parents with young children entering the site.
As the crowds surge into the mausoleum, vaccinators immunize a new child every few seconds at fixed points at the entrance and exit, whilst others mingle with the crowds, searching for any young child without a purple stained finger – the sign used to indicate that they have been vaccinated.
This year, 11 409 children were vaccinated at Mazar-e-Quaid over the course of Independence Day. With such a small team, this is an impressive achievement.
Mehwish Sheikh is a vaccination supervisor at Mazar-e-Quaid and is considered to be one of the most dynamic polio eradicators to have ever worked there.
Talking about her passion for polio eradication, and what drives her to protect Pakistan’s children, she says,
“Working against polio is in my blood. My mother started as polio worker in 1992 with the start of the polio eradication drive. Following her, I have worked for more than a decade now.”
“My mother vaccinated the current Chairman of Pakistan People’s Party Mr. Bilawal Bhutto Zardari, and she was featured on television and newspapers. My sister is also a vaccination worker so vaccination and work against polio is our passion.”
“Will you believe that I took only 3 days off on my wedding and then rejoined the team here?”, she laughs.
So what is it like vaccinating on Independence Day?
Mehwish isn’t afraid to acknowledge the challenges that the teams face on 14 August each year.
“This is really a tough day for all of us because the number of people is so overwhelming. Peoples’ connection with their leader is especially strong on Independence Day.”
With a wry smile, she continues, “Of course, our real independence will be our independence from polio virus.”
The parents
Whilst vaccination in this context might seem unexpected, parents visiting the Mausolem are enthusiastic. This is thanks to the efforts of the Pakistan polio programme and the government to educate the population about the vaccine.
One father notes, “As parents, it’s our duty to protect our children from going into harm’s way and administering all sorts of vaccines is one way of doing this.”
A nearby mother concurs, “The vaccinators are here to save the lives of our children and we must cooperate with them.”
The eradication of polio in Pakistan will be a success for thousands of people involved in the programme, and a source of national pride.
Speeding past to vaccinate more children, one vaccinator calls out, “We want to see our names among those who are fighting the final battle against polio in Pakistan”.
In April 2016, the polio programme embarked on a massive, coordinated effort to withdraw Sabin type-2 from routine use, through a synchronized switch from the trivalent formulation of the oral poliovirus vaccine (tOPV) to the bivalent form (bOPV). Over a two-week period, 155 countries and territories successfully made this change, marking the largest and fastest vaccine rollout in history.
Referred to as simply “the switch,” this global undertaking was a major programmatic achievement, but it was also a necessary step on the road to eradication. That’s because, in rare cases, the live, weakened virus contained in OPV can mutate and spread, resulting in cases of circulating vaccine-derived polioviruses (cVDPVs). The vast majority of these cases are caused by just one of the three components contained in tOPV (Sabin type-2 virus), so switching to a bivalent form that doesn’t contain this component was an attempt to significantly minimize the risk of further cVDPV2 cases – a decision that was endorsed by the global health community. Further, with Sabin type-2 responsible for 40% of vaccine-associated paralytic polio (VAPP) occurrences – a much rarer phenomenon at 2-4 cases per 1 million ‒ there was even stronger justification for the switch.
To assess whether the switch was successful, a group of researchers from Imperial College London, the World Health Organization and the Bill & Melinda Gates Foundation analysed stool and sewage samples from 112 countries collected in the first 15 months after the switch. The results, published in The New England Journal of Medicine, show that VDPVs and Sabin type-2 excreted into the environment after vaccination disappeared rapidly after the switch, shrinking to a much smaller geographic area.
These findings validate the GPEI decision to withdraw tOPV and demonstrate that the switch achieved its desired goal of reducing VDPVs and VAPP. This research also provides important evidence that the complete withdrawal of OPV after eradication of all wild polioviruses will eventually eliminate the risk of VDPVs, provided high immunity and effective surveillance are maintained. Eradication is simply not compatible with continued use of OPV.
The study also showed, however, that while some outbreaks of VDPV were expected post-switch, the number and magnitude of some of these outbreaks in different geographies has proven more difficult to control than expected. Type-2 VDPV outbreaks outside of Africa have been responded to with monovalent type-2 OPV (mOPV2) and controlled. However, outbreaks in the Horn of Africa, DR Congo and Nigeria have been very difficult to bring to a rapid close.
VDPV outbreaks emerge in areas with very low population immunity, due to low immunization coverage. Factors which enable them ‒ insecurity and resulting inaccessibility, weak health systems, and poor campaign performance – are the same that need to be addressed to stop their transmission. While the programme is aware of these risk factors and has proven experience and strategies to respond to them, the longer outbreaks persist, the harder they can be to stop.
The key to stopping these outbreaks will be to increase the focus on improving the quality of vaccination campaigns in accessible areas. In inaccessible areas, we need to use all available means to negotiate access and implement vaccination campaigns. Achieving high quality campaign activities will give us the best chance to stop all types of poliovirus for good and prevent any child from being paralysed by the virus ever again.
“Please wait, I’ll soon be with you,” says Nasiru, the father of six children, as he disappears into his house in Gagi Makurdi settlement in Nigeria’s northwestern State of Sokoto.
Within minutes, Nasiru reappears, proudly displaying immunization cards with the record of the vaccines given to his youngest three children. It is unusual for fathers in this conservative part of Nigeria to readily know the whereabouts of these documents. Tending to children and ensuring that they stay healthy is usually a mother’s job.
“Take a look at the cards. My children Fidausi and Fatima have completed all their required immunization, whilst my youngest, Nana Asmaiu, is well on course to complete his,” he says.
Nasiru is a champion for immunization, but he wasn’t always so enthusiastic.
20 000 community mobilizers
It was Hauwa Ibrahim, a 46-year-old UNICEF-trained Volunteer Community Mobilizer, who persuaded Nasiru that the vaccine was safe and effective. She is part of a 20 000-strong network of community mobilizers who work across twelve Nigerian states like Sokoto, where some communities have been resistant to polio vaccination.
As recently as 2012, Nigeria used to account for half the world’s polio cases. Today, with help from women like Hauwa, no wild poliovirus has been detected in the country since August 2016. There are still many immunity gaps in Nigeria – as underlined by an outbreak of vaccine-derived virus currently ongoing in the country – but in the villages where VCMs like her work, these gaps are beginning to close.
Using a simple register, Hauwa goes house to house in Gagi Makurdi to record all children below the age of five, as well as women who are pregnant. It is the same register that Hauwa used to track the pregnancies of Nasiru’s wife – Zara’u – and she now uses it to find out who manages the routine immunization schedules of the three youngest children in the household.
Strengthening routine immunization
This forms part of the polio programme’s work in Nigeria to strengthening routine immunization, building on the infrastructure developed to eradicate the virus.
Upon her first visit, Hauwa was determined to convince Nasiru that vaccination against polio and other diseases is important – and that he should take the children to the health facility.
“My culture does not allow a wife to go outside of the compound, so when Hauwa insisted that we take our children to the health facility for vaccines, I had no way but to go myself. Else, Hauwa would not give up,” Nasiru explains. Whilst he travels with his children, Zara’u takes care of their older siblings at home.
By recruiting locally influential women like Hauwa from communities where some parents are vaccine-hesitant, and training them to be advocates for child health, vaccination rates are improved throughout their neighbourhoods. In some areas, more than 99% of parents now accept the polio vaccine for their child.
“Hauwa resides in this settlement and I trust her; I trust that the advice she is giving is in the best interest of my children,” says Nasiru.
He also notes, however, that he is often the only man at the health facility.
Engaging all fathers
Hauwa hopes that by encouraging more fathers to take on the parental responsibility of completing their children’s routine immunization schedule, immunization coverage will increase across Sokoto. Greater vaccine acceptance and awareness means that children are more likely to receive a life-saving polio vaccine, and other vaccines, whether through routine immunization or through door-to-door vaccination.
Already, the trust that she has built amongst parents in Gagi Makurdi has helped surmount many of the barriers that deny children immunization and other health services. In Nasiru and Zara’u’s compound, nearly all children are now protected against polio and other vaccine-preventable diseases.
Only their baby, Nana Asmaiu, has yet to have all his vaccinations – and Hauwa will soon visit his household to support Nasiru and Zara’u, and ensure he gets them.
Long distances, an ever-changing environment and minimal infrastructure are only a few of the barriers that the Lake Chad Task Team face as they conduct polio vaccination and surveillance activities in response to wild poliovirus detected in Nigeria in 2016. Overcoming these hurdles isn’t easy, but innovations ranging from geographical information systems (GIS) technology to boat-side vaccination are going far to ensure that every child is reached with lifesaving vaccines.
“I have heard of several more islands that have appeared since the dry season began”, says a local official as he discusses plans for a vaccination campaign about to be held near Bol, the main lake-side town in Chad. Unique climate conditions contribute to fluctuating water levels, and land is built up and destroyed within weeks. Now, new information is recorded using geographical information systems (GIS) technology, increasing the accuracy of regional vaccination plans, and ensuring that health workers visit every community with vaccines.
Travelling via speedboat reduces the journey time to islands from days, to hours. The team have invested in dedicated vessels for polio eradication activities, freeing them to travel at a moment’s notice to investigate a case of acute flaccid paralysis, or deliver vaccines. These stable, tough boats are specially chosen for long distance journeys.
Arriving on an island, the team supervise the activities of community-based vaccinators, ensuring that every child receives two drops of polio vaccine, and that their finger is stained purple to distinguish from those children not vaccinated. Vaccination activities happen in markets, villages, and nomadic settlements. Recruiting women and men to work in their local communities increases vaccine trust and acceptance. This is one of the key lessons learned over the course of the global polio eradication programme.
As temperatures soar, it’s critical that the polio vaccine is kept cool, an immense challenge in places where there is little or no electricity. A game changer for the team has been the introduction of dedicated vaccine refrigerators, some solar powered, painstakingly transported to and installed in several island villages. This means that vaccines are kept cold week to week, reducing the amount that must be transported by the team for each campaign, and limiting vaccine waste.
“Seeing how healthcare is so important, especially for mothers and children, I was inspired”, says Ahmad, an IT expert. During each campaign, he travels to distant villages to train local health workers on new technology to ensure high quality vaccination campaigns. Using specially-designed mobile phone applications, the team helps ensure that every household is visited by vaccinators.
“Can you tell me how to recognize the symptoms of a potential polio case?”, asks Dr Adele. She records the answer given by Robert, who is the coordinator of a small island health centre, on a mobile phone used as part of electronic disease surveillance (also known as Integrated Support Supervision). Conducting regular disease surveillance monitoring allows the task team to ensure that every case of acute flaccid paralysis has been properly reported. At the same time, they reinforce best practice for disease surveillance. This has the added benefit of ensuring that the team maintains a close relationship with health workers, many of whom live days’ journey from the nearest hospital.
Calling out in French, Arabic, and local dialects, the team speak to parents in passing boats and wooden pirogues, “We’re vaccinators, let us see your child’s finger mark!”. Drawing alongside every vessel as they journey to and from villages, the polio eradication team ensure that all travelling children have received two drops of the safe, effective oral polio vaccine. Families journeying across the lake are often headed to markets, where unvaccinated children could potentially spread the virus as they play. Before they continue on their way, the team diligently vaccinate every child without a stained finger.
No wild poliovirus has been detected since September 2016, after outbreak response began in the Lake Chad Basin. Vaccination rates are higher, whilst investment in polio eradication operations and infrastructure has helped to strengthen the wider health system in the lake. The tools and strategies of the Task Team are defeating polio, and leaving a strong legacy that other health programmes can follow.
At Malahang health clinic near Lae in Morobe Province, a health worker administers the oral polio vaccine (OPV) at a supplementary vaccination activity targeting children under five years. As part of the health ministry’s response to Papua New Guinea’s recent polio outbreak, four additional rounds of OPV vaccination are planned in Morobe, Madang and Eastern Highlands provinces.
An aerial view near Lae, Morobe Province. Papua New Guinea’s first polio outbreak since 1996 was first identified at Lae. Low immunization coverage rates, poor water sanitation and hygiene all contributed to cases of circulating vaccine-derived poliovirus (cVDPV).
Officer-in-charge Daisy Basa (centre) checks a child’s vaccination card at the Malahang Health Clinic. More than 2900 health workers, vaccinators and volunteers have been mobilized to vaccinate almost 300,000 children under five years old in Morobe, Madang and Eastern Highlands provinces.
Locals in traditional dress provide entertainment for families attending the supplementary vaccination sessions at Malahang health clinic. A national public awareness campaign has played a key part in the Government’s comprehensive response to the polio outbreak, helping to maximise vaccine coverage of children under five years old.
The National Department of Health (NDOH) is leading efforts to limit the spread of the disease, in collaboration with WHO, GPEI and other partners. As well as the supplementary vaccination sessions, the National Public Health Emergency plan includes strengthening surveillance systems for early virus detection. WHO is supporting this work, ensuring swift investigation of every case of suspected polio paralysis.
Vaccine supplies are loaded into the cold room at the Morobe Province supply store in Lae. Thanks to the quick response of the National Department of Health (NDOH), along with WHO and other partners, thousands of children have already been vaccinated. Efforts continue to detect and protect against the virus.
This is southern Afghanistan. A place characterized by a rich, diverse, but often complex history. Enveloped by mountains, this part of the country has seen years of conflict which have left hospitals under-resourced and health services shattered. Children face many challenges – as well as conflict and poverty, southern Afghanistan has the highest number of polio cases in the world.
In this difficult environment, the virus can only be defeated if every child is vaccinated.
Afia (not her real name), who is nineteen years old, is one of over 70 000 committed polio workers in Afghanistan, supported by WHO and UNICEF. Last month, she and her colleagues vaccinated 9.9 million children and educated thousands of parents about vaccination across the country.
The polio eradication programme comprises one of the biggest female workforces in Afghanistan: a national team, all fighting polio. Some women work as vaccinators, whilst others, like Afia, are mostly engaged in education and social mobilisation efforts. The polio programme gives women culturally-appropriate opportunities to work outside the house and engage in their community, speaking to parents about the safe, effective polio vaccine, and answering their questions. Often, women vaccinators offer other kinds of health advice, including recommendations for good child and maternal health.
To be a good vaccinator and educator, women must be committed to better health for all, with strong communication skills. They must also be organized to ensure that every child is reached during the campaign.
Afia says that if she wasn’t eradicating polio, her parents would expect her to give up her education and get married. Her younger sisters look up to her, excited to work in the polio eradication programme when they are old enough.
Her job is very important to protect all children. Afghanistan is just one of three countries – the others are Nigeria and Pakistan - that have never interrupted poliovirus transmission.
Women can vaccinate children who might otherwise miss out. Culturally, male vaccinators are unable to enter households to administer vaccine, causing difficulties if young children are asleep or playing inside. Their freedom to enter homes and give the vaccine to every child is one reason female polio workers are so critical.
Afia started work at 7 am, and is now walking home ten hours later with a young boy she has just vaccinated. Her purple burka stands out against the sand as she goes home to tell her parents and siblings about her day.
Afia feels positive about the future of polio eradication in Afghanistan: “We have a duty to protect our children, and I won’t stop working until every child is protected.”
Women have a right to participate in all aspects of polio eradication. Removing barriers to women’s full participation at all levels is a key goal for the Global Polio Eradication Initiative (GPEI). To learn more, see the gender section of our website, and read the GPEI ‘Why Women’ Infographic.
Molvi Hameedullah Hameedi is a prominent religious scholar in a mountainous rural area of Killa Abdullah district, one of the poorest districts in Balochistan province, Pakistan. With a close connection to his community, who are mostly Pashtuns, he delivers the sermon each week during Friday prayers, and runs a religious seminary.
He is also a determined supporter of routine vaccination for all children, and an advocate for better health.
This might come as a surprise if you met Molvi Hameedullah just a year or two ago. For most of his life, he did not believe in the safety and effectiveness of the oral polio vaccine, the key tool of polio eradication.
“I was a religious scholar who was very sceptical of non-governmental organizations and the polio vaccine,” he reflects.
“After reading anti-vaccine books and papers, I began following the work of anti-vaccine campaigners. Soon, I came to consider it my religious duty to spread awareness against the polio vaccine.”
“But it all changed when I was invited to a two-day International Ulema conference in Islamabad where religious scholars from all over Pakistan and other Islamic countries were invited to debate polio vaccination.”
The conference Molvi Hameedullah attended was hosted by the Islamic Advisory Group for Polio Eradication (IAG). The IAG was launched in 2014 by leading Islamic institutions including Al-Azhar University, the International Islamic Fiqh Academy (IIFA), the Islamic Development Bank (IsDB) and the Organization of Islamic Cooperation (OIC).
For Molvi Hameedullah, attending the conference marked the beginning of a change in perspective. “At the conference, I was given an opportunity to discuss my apprehensions towards polio vaccine. The talks I had motivated me to further research the pro-polio vaccine stance, and I started meeting with religious scholars in Karachi to debate polio vaccination.”
“Through talking to these people, I was getting a completely different picture to what I had believed earlier.”
By educating religious leaders and scholars about the poliovirus, and explaining religious justifications for vaccine acceptance, the IAG and its national equivalent equip people like Molvi Hameedullah with the tools to act as health advocates. The same skills that help scholars engage with parents about the polio vaccine are applicable for wider health, including improving routine immunization, hygiene practices, and maternal and child health.
After the conference Molvi Hameedullah was offered support by other vaccine-promoting scholars.
“I received a book from a religious support person working for polio vaccination in my area. Included were dozens of fatwas from highly esteemed madrassahs and religious teachers. I was initially sceptical, so I telephoned the madrassahs who had written them. To my surprise, all the fatwas were genuinely issued by them, and they also urged me to support vaccination wherever I called.”
Today, Molvi Hameedullah teaches similar fatwas as a member of the Provincial Scholar Task Force under the National Islamic Advisory Group. Most Task Force members have an honorary position, and are not paid a salary. Instead, the local government facilitates their transport and communication needs during immunization campaigns. Of his new role Molvi Hameedullah says, “I was faced with a different problem. I had been working against polio vaccination for many years, and now felt that I had done a great damage to the children and parents of my community. I felt it was now my absolute religious duty to negate all that I had taught before. I decided to step forth, and started working in the community voluntarily to promote vaccination.”
Religious refusals in Molvi Hameedullah’s area have declined. He has begun supporting other ways of ensuring that every child receives a vaccine, including by recruiting women vaccinators.
He acknowledges that the work he does now is not easy. He and his fellow scholars sometimes face challenges from those accusing them of having a political agenda, and changing beliefs informed by years of cultural and religious tradition takes time and patience. But he vows to continue his new mission until eradication.
There have been no cases of polio in the area of the district that Molvi Hameedullah covers since he joined the Provincial Scholars Task Force. Looking ahead, he is determined not to stop until all of Pakistan is polio-free.
A new study published this month in the Journal of Infectious Diseases has shown that a single dose of fractional dose inactivated poliovirus vaccine (fIPV) boosts mucosal immunity to a similar degree as a full dose of IPV, in children previously immunized with oral polio vaccine (OPV). During the current IPV shortage, this vaccine is not recommended for outbreak response, however, if it is used, then this finding provides further evidence in support of fIPV rather than full dose IPV at a time of IPV global supply shortage.
The efficacy of fIPV in boosting humoral immunity (offering individual protection against paralytic disease) in comparison to full-dose IPV had already been established, and this dose-sparing approach for routine immunization programmes was subsequently recommended by the Strategic Advisory Group of Experts on immunization (SAGE). Thanks to an increasing number of countries adopting this approach, including Bangladesh, India, Nepal, Sri Lanka, Cuba and Ecuador, there have been significant improvements in the global supply of this vaccine.
These latest findings show that fIPV also has a significant role to play in outbreak response. Mucosal immunity is needed to interrupt person-to-person spread of the virus in a community, so is a critical factor in outbreak response. Used in conjunction with OPV, even a single dose of this formulation could now play a key role in such settings, by rapidly boosting mucosal immunity at a similar level to a full-dose IPV while using a fifth of the vaccine amount. This has clear benefits both on cost and supply.
“Globally, demand for IPV is high and the supply is constrained,” commented Dr Tahir Yousafzai from Aga Khan University in Karachi, Pakistan. “As polio eradication is gradually eliminating OPV, countries will eventually rely solely on IPV, further increasing demand. Fractional IPV can stretch the limited IPV supply and provide similar humoral and mucosal protection when compared to full-dose IPV in children vaccinated with OPV. In addition, it will play an important role in stopping poliovirus transmission, and hence help in the eradication of wild poliovirus and circulating vaccine-derived poliovirus.”
For the post-polio era, the Global Polio Eradication Initiative and its partners are continuing to explore new IPV approaches to ensure an affordable and sustainable supply following global polio eradication, including through the use of IPV vaccine manufactured from Sabin strains or non-infectious materials such as virus-like particles.
The first of four large-scale immunization campaigns is set to kick off in Papua New Guinea next week, following last month’s confirmation of a circulating vaccine-derived poliovirus type 1 (cVDPV1). More than 2900 health workers, vaccinators and volunteers have been mobilized to vaccinate almost 300 000 children under 5 years of age in Morobe, Madang and Eastern Highlands provinces. The campaign from 16-29 July is the first in a series of vital immunization campaigns planned every month for the next four months.
“Polio is back in Papua New Guinea and all un-immunized children are at risk,” said Pascoe Kase, Secretary of the National Department of Health (NDOH). “It is critical that every child under five years of age in Morobe, Madang and Eastern Highlands receives the polio vaccine during this and other immunization campaigns, until the country is polio-free again.”
As polio is a highly infectious disease which transmits rapidly, there is potential for the outbreak to spread to other children across the country, or even into neighbouring countries, unless swift action is taken. With no cure for polio, organisers of the immunization drive are calling for the full support of all sectors of society to ensure every child is protected. Parents living in the three provinces are encouraged to bring their children to local health centres or vaccination posts to receive the vaccine, free of charge, during the campaign.
“Everyone has a role to play in stopping this terrible disease,” commented Dr Luo Dapeng, WHO Representative in Papua New Guinea. “We call on parents to bring your children under five years of age for vaccination, irrespective of previous immunization status. Together, we can help ensure that this outbreak is rapidly stopped and that no further children are paralysed by polio.”
The Officer In Charge for UNICEF Representative, Ms. Judith Bruno, stressed, “As long as the polio virus persists anywhere, all un-immunized children remain at risk, and since polio carries enormous social costs, we must make it a key priority to stop its transmission so that children, families and communities are protected against this terrible disease.”
The immunization campaign is organized by the National Department of Health and the Provincial Health Authorities, with support from the World Health Organization (WHO), UNICEF, Rotary International and other partners.
Campaign dates are:
• First Round: 16-29 July 2018
• Second Round: 13-26 August 2018
• Third Round: 10-23 September 2018
• Fourth Round: 8-21 October 2018
Following confirmation of the cVDPV1, on 22 June the National Department of Health of Papua New Guinea immediately declared the outbreak a ‘national public health emergency’, requiring emergency measures to urgently stop it and prevent further children from lifelong polio paralysis. The measures implemented by the government intend to comply fully with the temporary recommendations issued under the International Health Regulations ‘Public Health Emergency of International Concern (PHEIC)’.
Papua New Guinea has not had a case of wild poliovirus since 1996, and the country was certified as polio-free in 2000 along with the rest of the WHO Western Pacific Region. In Morobe Province, polio vaccine coverage is suboptimal, with only 61% of children having received the recommended three doses of polio vaccine. Water, sanitation and hygiene are also challenges in the area, which could contribute to further spread of the virus.
Dar es Salam refugee camp, in Bagassola district, Chad, is home to thousands of refugees. 95% of the population is Nigerian, displaced by years of violent insurgency, drought and insecurity in the Lake Chad basin. Some have lived in the camp since 2014.
Here, temperatures soar to 45 degree Celsius nearly every day. Dust is inescapable, colouring everything a shade of yellow. Houses are constructed from tents, tarpaulins and reeds, pitched onto sand. There is no employment, few shops, and no green areas.
Kilometers from the lake, residents have no access to the water around which their livelihoods revolved, as fishing people, as traders at the markets located around the island network, or as cattle farmers. This renders them almost entirely reliant on aid. The edge of the camp is an enormous parking lot, filled with trucks loaded with donations. Signs interrupt the landscape, attributing the camp’s schools, football pitches, and water stations to different funding sources.
Polio immunization is a core health intervention offered by the health centre here, with monthly house to house vaccination protecting every child from the virus.
“We vaccinate to keep them healthy”
In return for their work, vaccinators receive a small payment, one of the few ways of earning money in the camp. In Dar es Salam, there are thirty positions, currently filled by 24 men and six women, and applications are very competitive. Those chosen for the role are talented vaccinators, who really know their community.
Laurence speaks multiple languages, adeptly communicating with virtually everyone in the camp. He is a fatherly figure, engaging parents in conversations about the importance of vaccination whilst his colleague gives vaccine drops to siblings. Their mother is a seamstress, constructing garments on a table under one of the few leafy trees. Laurence engages her in conversation, explaining why the polio vaccine is so important.
Describing his work, he says, “I tell parents that the vaccine protects children from disease, especially in this sun, and that we vaccinate every month to keep them healthy.”
A precious document in a plastic bag
Chadian nationals living in nearby internally displaced persons camps don’t have the same entitlements as international refugees. Several hours’ drive from Dar es Salam, children lack access to even a basic health centre.
At a camp in Mélea, vaccinators perform routine immunization against measles and other diseases under a shelter made from branches. Cross-legged on the ground, they fill in paperwork, carefully administer injections, sooth babies, and dispose safely of needles. Other vaccinators give the oral polio vaccine to every child under the age of ten. These children are mostly from the islands, displaced by insurgency. Their vaccination history is patchy at best, and it is critical that they are protected.
One father arrives accompanied by his small, bouncy son. As the baby looks curiously at the scene in front of him, his dad draws out a tied plastic bag. Within is his son’s vaccination card, carefully protected from the temperatures and difficult physical environment of the camp.
A UNICEF health worker reads it, and realizes that the child is due another dose of polio vaccine. Squealing with confusion, the baby is laid back in his sibling’s arms, and two drops administered. The shock over, he is quickly back to smiling, rocked up and down as his dad folds up the card, and ties it up in the bag once more.
Back in Dar es Salam, DJórané Celestin, the responsible officer for the health centre explains the wider challenges of vaccination in this environment.
“We don’t just vaccinate within Dar es Salam in our campaigns. We are also responsible for 27 villages in the nearby surroundings. Reaching these places proves our biggest challenge.”
Away from the main route to Dar es Salam, there are no roads or signs, and many tracks are unpassable. To reach the 539 children known to live in the villages, vaccinators walk, or rent motorbikes, travelling for many hours.
This month, another round of vaccination in the Lake Chad island region concluded. Hundreds more refugee and internally displaced children are protected, in some of the most challenging and under-resourced places to grow up.
Three-year-old Ibrahim wouldn’t stop crying. Suffering from ringworm, a fungal infection, his leg had become badly infected. Left untreated, he risked developing fever and scarring wounds.
For Ali Musa, his father, it was hard to know where to turn for help. Where he lives, in the nomadic community of Daurawa Shazagi in the Nigerian state of Jigawa, there is little access to professional medical treatment.
From his home, it would take Ali a full day to trek to the nearest primary health centre. He does not recall the last time anyone in his community made this “practically unthinkable” journey.
Reaching all children with vaccines
“But when I heard in the market that a medical team was coming to us to treat sick people, especially women and children, I went with the hope to at least get him some relief from the pain,” Ali recalls.
There, Ali met members of the mobile health teams supported by the UNICEF Hard-to-Reach (HTR) project – funded by the Government of Canada’s Department of Foreign Affairs, Trade and Development. These teams are helping to ensure that children receive polio vaccinations, whilst also providing basic health services – including medications to fight infections like ringworm – in hard-to-reach areas of Nigeria.
The teams vaccinate against measles, meningitis and other diseases, and provide vitamin A supplements and deworming tablets for children. They also carry out health promotion activities, teaching communities about important practices such as exclusive breastfeeding. During each clinic, members of the HTR team give two drops of polio vaccine to every child, ensuring that all are protected from the virus.
At the end of their visit, the team pack up the clinic, and travel home, taking hours to cross difficult terrain by foot, boat and motorbike.
2390 children vaccinated
The HTR project aims to reduce the immunity gap among children living in Nigeria. Since 2016, when cases of wild poliovirus last were detected in the country, determination and commitment have helped to strengthen eradication efforts, but many states still face an uphill task to increase historically low routine immunization rates. This is especially the case in rural areas, where there are few services, and communities have to travel far to the nearest health clinic.
So far in 2018, the project has reached thousands of previously unvaccinated children with the life-saving polio vaccine, including 2390 children in Ibrahim’s state, Jigawa.
“Why should I let anything stop me?”
Salamatu Kabir, who leads a HTR team assigned to take immunization and basic health care services across Jigawa, says “I look at it this way. If people from outside can come all the way to bring the hard-to-reach project to my country, why should I let anything stop me from delivering it to my own people who are most in need?”
A retired health worker, she says that she doesn’t think twice about the many hurdles that she will have to overcome to reach children in communities like Ali and Ibrahim’s.
Far more of a concern is planning meals for her four children whilst she is away, and packing all the equipment she will need for the journey. Experience over the years has taught her what items to add to her bag besides vaccines. She always carries an umbrella, an extra pair of clothes, insect repellant and depending on the season, either an additional pair of sandals or, most often, rain boots.
Salamatu asserts that for the team members, “visiting the settlements to administer health care is something we have come to love and look forward to”.
When the team finally does arrive at their destination they are greeted by an expectant community. Salamatu is motivated by the direct impact her work has on the lives of others.
Little Ibrahim is one of those to benefit. After treatment from the team, his condition improved quickly. His father Ali has since become a volunteer for the HTR project, and an avid advocate within his community for medical care.
“I will do my best to ensure every child in my village benefits from the help that is coming from far,” he says.
A pale blue sky stretches from east to west. The ground is dusty, the journeys of thousands of people compacting it into a hard dirt track. Ahead stands a structure known as the Friendship Gate – with people laden with bags and boxes weaving paths beneath it. This isn’t an ordinary street, but a border crossing between Afghanistan and Pakistan, where people, goods, livestock, and sometimes, the poliovirus, pass from one country to the other.
Porous borders, which enable the continuous movement of people between countries, are a contributing factor to poliovirus transmission in Afghanistan and Pakistan. Along with Nigeria, these are the only wild poliovirus endemic countries in the world. Look at a map of poliovirus cases and positive sewage samples over time, and transmission ‘corridors’ can be clearly seen, evidence of the virus passing consistently between the countries. Every year for decades, the virus has made it over the border through key entry and exit points, hiding in children.
Spin Boldak in southern Afghanistan and Chaman in western Pakistan are both important border crossing points centrally positioned in what is known by epidemiologists as the ‘southern corridor’. Today, thanks to collaboration between the governments of Afghanistan and Pakistan, and the efforts of hundreds of thousands of individuals working to fight the virus, this important crossing is attended by polio vaccinators, seven days a week, 24 hours a day. With two drops of safe, effective vaccine, they ensure that every one of the thousands of children under the age of ten entering the other country each month leaves the poliovirus behind.
To defeat the virus, polio eradicators seek to understand the push and pull factors of people crossing the border. Many are traders, some seek medical treatment in Pakistan, others visit relatives on both sides of the border. Many have sought refuge in Pakistan, or are forced returnees. Many come from areas where health systems are weak, and some children have never been vaccinated before.
To defeat the virus, Afghanistan and Pakistan have built strong relationships. Studded along the border – which weaves from north to south, through mountainous areas, deserts, and between busy cities– are 15 WHO and UNICEF supported vaccination posts, hosting 42 vaccination teams. Each month, they vaccinate tens of thousands of children for free, no matter what their nationality or reason for being at the border.
Dressed in Rotary ‘End Polio Now’ hats, and surrounded by bright banners, the cross-border health workers also watch out for children travelling across the border presenting signs of acute flaccid paralysis, an indicator of potential polio infection. Vaccinators also speak to parents, educating them about the importance of vaccines, and the other immunization services that they can get free-of-charge in the country they are crossing to. For many without free professional health-care, this is a crucial service. Most arrive unaware of the benefits they can gain to protect their children’s health, and this information is not always easy to come by.
The polio programme also works with other humanitarian organizations near the border. As the situation changes, with refugee numbers fluctuating accordingly, the vaccination teams work to ensure children can be reached at or near the border, with few missed. In April, 2289 children under the age of ten, mostly from Pakistan and Iran, were vaccinated near the border with oral polio vaccine by teams receiving them into UN Refugee Agency (UNHCR) repatriation centers and sites run by the International Organization for Migration (IOM).
Polio vaccination at the border prevents the reintroduction of the virus into areas of Afghanistan and Pakistan where no cases or environmental positive samples have been seen for some time, and reduces incidence of the virus in areas where it is still circulating. Our team gives every child a strong start in life – whether they are a refugee or a returnee, and irrespective of their place of origin. As the team in Spin Boldak and Chaman finishes its shift for the day, the next team continues their task: to protect all children at the border, and help end polio.
In the fight against the virus, two important tools are used to help prevent polio – two safe, effective vaccines. Only through full funding of these vaccines can worldwide immunity be achieved, and the virus eradicated.
Redoubling commitment towards this goal, last week, Gavi, The Vaccine Alliance, approve core funding for the inactivated poliovirus vaccine (IPV) for 2019 and 2020, to continue work to end polio, and protect every child.
Announcing this support, Gavi Board Chair Dr Ngozi Okonjo-Iweala said, “Polio will remain a threat until every child is protected against this crippling disease. That is why the vaccination of every child is the corner stone of the polio eradication effort. Introducing IPV to all countries to interrupt polio transmission and maintain zero cases represents an unprecedented push, and Gavi is proud to be part of it.”
Since 2013, the Gavi Board has supported IPV in all 70 Gavi-supported countries, through a dedicated funding stream financed by the Global Polio Eradication Initiative (GPEI) budget. Responding to continued wild poliovirus circulation in 2018, this most recent Gavi support represents an additional contribution, which will help ensure that the programme can continue its valuable work to protect every child worldwide.
The Gavi Board also approved an exceptional extension of support for Nigeria up to 2028, to help reach over 4.3 million under-immunized children in the country, who remain at risk of vaccine-preventable diseases including polio.
Michel Zaffran, Director of the Polio Eradication Programme at the World Health Organization, extended his thanks to the Gavi Board for their generous contribution, saying, “GPEI and Gavi are committing to work closer together than ever before, and take one more step towards the immunization of all children, to deliver and to sustain a polio-free world.”
For 15 years Daeng Xayaseng has been travelling through rugged, undulating countryside by motorbike and by foot to deliver vaccines to children in some of the most remote villages in Laos.
It’s hard work but she is determined: “We have a target of children to reach and we’ll achieve that no matter how long it takes,” she says. “We’ll keep working until we reach every child.”
Today her team visits Nampoung village, 4 hours north of the capital of Laos, to deliver polio vaccines.
“For 15 years I’ve been working on campaigns like this,” she says. “Today we’re here with our outreach team to vaccinate children against polio. We’ll also go house to house to make sure no child misses out on being vaccinated.”
“We don’t want there to be another outbreak of polio so we have to reach everyone,” says Daeng. “In order to do that, immunizing every child in remote communities like this is a priority to ensure everyone is protected.”
UNICEF and other partners of the Global Polio Eradication Initiative are supporting the Lao Government to reach nearly half a million children under five with potentially life-saving vaccines. More than 7,200 volunteers and 1,400 health workers like Daeng and her team have been mobilized to deliver the oral polio vaccine as well as other vaccinations such as measles-rubella.
“I’m very happy and proud to do this job,” says Daeng once the team has packed up. “I’m proud to do this job to serve the community and help in any way I can.”
A vaccine manufacturer in Stockholm has taken the first step towards becoming a certified Poliovirus Essential Facility (PEF), leading the charge in global efforts to safely and securely contain type-2 poliovirus. This facility has been awarded a Certificate of Participation co-signed by the National Authority for Containment (NAC) in Sweden and the Global Commission for the Certification of Poliomyelitis Eradication (GCC). The Certificate is the first of its kind to be issued, indicating formal engagement in the global containment certification process.
Wild poliovirus type-2 was declared eradicated by the GCC in September 2015, however, there is risk of the virus resurging. Following the removal of the type-2 component from oral polio vaccine (OPV) and the discontinuation of type-2 containing OPV from routine use in April 2016, countries around the world have been asked to safely and securely destroy their type-2 polio samples. As a further precaution, countries continue to immunize against type 2 polioviruses with inactivated polio vaccine. For facilities needing to retain the virus for vaccine production or for critical research, stringent containment measures need to be followed. The first step is getting a Certificate of Participation.
“We are pleased to see Sweden leading the way in demonstrating conforming with the processes to minimize the risk of releasing type-2 poliovirus into the environment. Participation in the Containment Certification Scheme shows that both the facility and the host country are serious about taking on and implementing the safeguard measures necessary to become a PEF,” said Prof. David Salisbury, Chair of the GCC and of the Commission’s European regional body.
“Handling and storing an eradicated pathogen is a risk and responsibility – a leak or breach could have devastating consequences,” said Michel Zaffran, Director of Polio Eradication at the World Health Organization. “We commend Sweden for its commitment towards ensuring safety standards are met and protocols are in place to help minimize risk, and for paving the road for the containment certification process,” he said.
“The issuance of a Certification of Participation formally engages a designated PEF in the containment process. Provided that the facility meets the requirements outlined in Global Action Plan III for the containment of polioviruses (GAPIII) within given time frames, it can then progress to achieving an Interim Certificate of Containment and finally, a full Certificate of Containment to become an accredited PEF,” said Prof. Salisbury. “Countries planning to retain type-2 poliovirus will need to establish their NACs as soon as possible, and by no later than the end of 2018. The GCC urges all countries that plan to have PEFs to get the ball rolling in this process,” he said.
Since April 2016, most facilities around the world have opted to destroy their type-2 poliovirus materials rather than contain them. Twenty-nine countries, however, plan to continue to handle and store their materials in 92 designated PEFs.
WHO will propose a resolution for consideration by the World Health Assembly in May to seek international consensus on accelerating containment efforts globally.
