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.
In London on 19-20 April, leaders of the 53 member states of the Commonwealth affirmed their commitment to end polio in the final Communique of the 2018 meeting. Leaders emphasized renewed support for international efforts to tackle polio and other diseases, and called for an increase in national health expenditure throughout the Commonwealth.
This outcome was largely thanks to the efforts of civil society, including outreach by members of Rotary clubs in Commonwealth countries, Global Citizen, and numerous other partners who urged Commonwealth leaders to uphold their commitment to polio eradication. This included the delivery of over 4000 messages to UK Prime Minister Theresa May appealing for her continued commitment to a polio free world.
Throughout the course of the summit and related events, individual leaders also voiced their continued support for eradication. Prince Charles, who will one day succeed Queen Elizabeth II as Head of the Commonwealth, held up the polio programme as an example of successful joint action against disease and noted that hundreds of millions of children have benefitted from polio vaccine because of the GPEI. The end of polio, he noted, will serve as an example of the Commonwealth’s proven track record in effecting change. Once eradication is achieved, polio infrastructure will be leveraged to address other health challenges, and may pave the way for malaria elimination. Incoming Chair of the Commonwealth Theresa May, in a direct letter to advocates, acknowledged that eradication “remains a top global priority,” and promised that the UK will “work closely with polio-endemic countries to ensure we eradicate this cruel disease, once and for all.” Malta’s Prime Minister Joseph Muscat, who has championed polio throughout his tenure as Commonwealth Chair, pledged during a speech to help end polio in Commonwealth countries Pakistan and Nigeria.
With a collective investment of more than US$ 4 billion and previous statements of commitment to polio eradication, Commonwealth governments have long-been leading champions to end polio. As Bill Gates noted during his summit remarks, “success [against polio] really goes back to the substantial commitments made in part at the Commonwealth meetings.” With a record low 22 cases registered last year, continued global support is vital to get the world over the finish line. The renewed support from the Commonwealth, which represents a wide range of countries, provides hope that governments remain firmly committed to fulfilling the promise of a polio-free world.
In 1977, the world was close to finally being smallpox free. The number of people infected had dwindled to only one man; a young hospital cook and health worker from Merca, Somalia named Ali Maaow Malin.
Before Ali, smallpox had affected the human population for three millennia, infecting the young, the old, the rich, the poor, the weak and the resilient.
Spread by a cough or sneeze, smallpox caused deadly rashes, lesions, high fevers and painful headaches – and killed up to 30% of its victims, while leaving some of its survivors blind or disfigured.
An estimated 300 million people died from smallpox in the 20th century alone, and more than half a million died every year before the launch of the global eradication programme.
Between 1967 and 1980, intensified global efforts to protect every child reduced cases of smallpox and increased global population immunity. Following Ali’s infection, the World Health Organization carefully monitored him and his contacts for two years, whilst maintaining high community vaccination rates to ensure that no more infection occurred.
Three years later, smallpox was officially declared the first disease to be eradicated. This was a breakthrough unlike any other – the first time humans had definitively beaten a disease.
But smallpox wasn’t the only deadly virus around
On March 26, 1953, Dr Jonas Salk announced that he had developed the first effective vaccine against polio. This news rippled quickly across the globe, leaving millions optimistic for an end to the debilitating virus.
Polio, like smallpox, was feared by communities worldwide. The virus attacks the nervous system and causes varying degrees of paralysis, and sometimes even death. Treatments were limited to painful physiotherapy or contraptions like the “iron lung,” which helped patients breathe if their lungs were affected.
Thanks to a safe, effective vaccine, children were finally able to gain protection from infection. In 1961, Albert Sabin pioneered the more easily administered oral polio vaccine, and in 1988, the Global Polio Eradication Initiative was launched, with the aim of reaching every child worldwide with polio vaccines. Today, more than 17 million people are walking, who would otherwise have been paralyzed. There remain only three countries – Afghanistan, Pakistan, and Nigeria – where the poliovirus continues to paralyze children. We are close to full eradication of the virus – in Pakistan cases have dropped from 35 000 each year to only eight in 2017.
Since there is no cure for polio, the infection can only be prevented through vaccinations. The polio vaccine, given multiple times, protects a child for life.
Better health for all
Thanks to vaccines, the broader global disease burden has dropped drastically, with an estimated 2.5 million lives saved every year from diphtheria, tetanus, pertussis (whooping cough), and measles. This has contributed to a reduction in child mortality by more than half since 1990. Thanks to an integrated approach to health, multiple childhood illnesses have also been prevented through the systematic administration of vitamin A drops during polio immunization activities.
Moreover, good health permeates into societies, communities, countries and beyond – some research suggesting that every dollar spent vaccinating yields an estimated US$ 44 in economic returns, by ensuring children grow up healthy and are able to reach their full potential.
Ali Maaow Malin, the last known man with smallpox, eventually made a full recovery. A lifelong advocate for vaccination, Ali went on to support polio eradication efforts – using vaccines to support better health for countless people.
Without the life changing impact of vaccines, our world would be a very different place indeed.
Binta Tijjani works to eradicate polio in her native Kano state of Nigeria. She is one of the over 360 000 frontline workers dedicated to ending polio in her country, the vast majority of whom are women. Nigeria is one of only three countries in the world yet to stop poliovirus circulation, together with Afghanistan and Pakistan.
Binta has worked in polio eradication for over 14 years. Starting as a house-to-house vaccination recorder, she was soon promoted to the role of polio campaign supervisor and now works as an independent polio campaign monitor.
“My biggest strength is my ability to work closely with our teams to ensure we reach every last child with vaccines, and advising teams so they can ask the right questions and raise important issues in each household they visit,” Binta says.
Working with the polio programme often opens up other opportunities for women to enter the workforce and utilize their skills to contribute to their communities, leading to positive investments beyond polio eradication.
“My work with the polio programme has enabled me to buy land and take care of my children’s school fees and our household needs. Currently I’ve enrolled in a course to get a certificate in catering. My dream is one day to open a restaurant,” Binta says.
Similar to Binta, Halima Waziri has been serving the polio eradication cause in different roles since 2005. Currently Halima works as a lot quality assurance sampling interpreter in Kano state, assessing the quality of vaccination coverage after immunization campaigns in her area.
“I am most proud of engaging in many productive dialogues about polio vaccination in remote and hard-to-reach areas and high-risk communities in Nigeria. This has helped me to improve my interpersonal communication skills and given me confidence in public speaking and influencing people,” Halima says.
With the money she has earned as a polio worker, Halima has opened a medicine store where she sells medicines and also acts as a community informant and focal point for disease surveillance.
Nigeria was on the brink of eradicating polio when a new wild poliovirus case was reported in 2016 after two years without any confirmed cases. Low overall routine immunization coverage is a key stumbling block to eradication, combined with ongoing violent conflict in the northeast where over 100 000 children remain inaccessible for vaccination teams.
Nigeria continues to implement an emergency response to vaccinate all children under the age of 5 to ensure they are immunized and protected, including implementing vaccination campaigns whenever security permits, vaccinating children at markets and cross-border points, and conducting active outreach to internally displaced people.
Without the critical participation of women as vaccinators, surveillance officers and social mobilizers, Nigeria would not be as close to eradicating polio as it is today. The latest nationwide immunization campaign, synchronized with countries in the Lake Chad basin, aimed to reach over 30 million children in Nigeria in April.
No wild poliovirus cases have been reported in 2017 or 2018. Binta and Halima, together with an army of frontline workers, are determined to keep it this way and secure a polio-free future for Nigeria.
From the front passenger seat of a small utility truck, Mahmoud Al-Sabr hangs out the window, looking for families and any child under five years old to be vaccinated against polio. As the car he travels in dodges rubble and remnants of buildings that once stood tall in Raqqa city, he flicks the ‘on’ switch for his megaphone.
“From today up to January 20, free and safe vaccine, all children must be vaccinated to be protected from the poliovirus that hit Syria for the second time,” he calls, beckoning families with young children who have recently returned to Raqqa city to come outside of their makeshift homes amongst destroyed buildings, to have their children vaccinated.
In 2017, amidst the protracted conflict and humanitarian crisis in Syria, an outbreak of circulating vaccine-derived poliovirus type 2 (cVDPV2) was detected, threatening an already vulnerable population.
Due to ongoing conflict, Raqqa city, which was once host to half of the governorates population, had been unreached by any vaccination activity or health service since April 2016. During the first phase of the outbreak response, more than 350,000 resident, refugee and displaced children were vaccinated against polio in Syria, but “Raqqa city remained inaccessible,” says Mahmoud.
In January 2018, polio vaccinators conducted the first vaccination activity in the city since it became accessible again, following the end of armed opposition group control.
There were no longer accurate maps or microplans that vaccinators could use to guide them in their work. Unrecognizable, the city was a picture of devastation with few dwellings untouched by the violence that once caused families to flee. The house-to-house vaccination campaign that usually helps the programme to reach every child under five wouldn’t work here. Teams knew they would have to innovate to seek out families wherever they were residing to vaccinate their children.
“All children must be vaccinated to protect against poliovirus,” Mahmoud echoes around shelled out buildings, and slowly mothers and fathers carrying their children start to appear in the street.
Mahmoud and Ahmed Al-Ibraim are one of 12 mobile teams that are going street by street, building by building, by car in search of children to vaccinate. Carrying megaphones to alert families of their presence and to tell them of the precious vaccines they carry that will protect their children from the paralysing but preventable poliovirus, they slowly cover areas of the city now unrecognizable.
“No one could enter Raqqa City now for two years,” says Abdul-Latif Al-Mousa, a lawyer from the city who joined the outbreak response as a Raqqa City supervisor for polio campaigns. “So children have not been vaccinated here since that time. Now that people have returned, we are learning where they have returned from and we vaccinate them regardless.”
“We must reach each child with the vaccine to protect them – polio is preventable, why should they suffer more?” Ahmed appeals.
Campaign brings vaccines and familiar faces
Vaccines were not the only thing to return to Raqqa City in January. It was the first time that WHO polio focal point Dr Almothanna could return to Raqqa City after being force to flee under the rule of the armed opposition group. Imprisoned for refusing the demands of the group, friends and neighbours of Dr Almothanna facilitated his escape from the city in 2016.
Dissatisfied but not deterred, Dr Almothanna continued to work with the polio programme, serving the whole governorate except his own city. Over the course of the January 2018 campaign, he worked tirelessly with vaccination teams to ensure more than 20 000 children under the age of five in Raqqa City received a dose of mOPV2 to protect them against polio. For many, it was the first vaccination they had received. In the additional campaigns that followed in March 2018, even more children were reached.
The microplans developed by vaccinator teams in the first vaccination round have become a critical road map for reaching children and families with health services, accounting for the locations of returned families and information about neighbouring families that teams had not yet located. In the second round, the microplans were updated to include new families who had returned.
Syria reported 74 circulating vaccine-derived poliovirus cases between March and September 2017. It has been more than six months since the last case was reported (21 September 2017). Efforts are continuing to boost immunity in vulnerable populations, maintain sensitive surveillance for polioviruses and strengthen routine immunization to enhance the population immunity.
Forty-year-old Auta A. Kawu says the only thing predictable about working in the conflict-affected northeastern Nigerian State of Borno is its unpredictability.
“No two days in my week are alike,” he says.
As a Vaccine Security and Logistics facilitator, Auta is one of 44 specialists working with the Government, UNICEF and partners in Nigeria, who strive to ensure sufficient vaccine stock, appropriate distribution and overall accountability for vaccines in the country. Through careful management, Auta works to give every accessible child in Borno protection from vaccine-preventable diseases, including polio.
Describing a typical week in his life, he explains that if on Monday he is arranging for the vaccination of eligible children among a group of Nigerians returning back from neighbouring countries where they had fled due to fear of violence, by Tuesday he could be speaking with government personnel to find a way to safely send vaccines to security compromised areas. On Wednesday, he may find himself rushing extra vaccines to an internally displaced persons (IDP) camp, where more people have arrived than initially expected, whilst on Thursday you may find him trying to locate a cold chain technician to fix a fridge where the heat-sensitive polio vaccine must be stored.
Evidencing the energy and commitment required to work on the frontline of vaccination, Auta notes that the work never lets up. Despite an exhausting week, on a typical Friday, you might find him on the road again, travelling to a remote location where health workers have just been given access. When he gets there, he will help out once more – trying to ensure that vaccines are distributed as effectively as possible to maximize the number of children reached.
He recounts a recent story of reaching the reception area of an IDP camp in Dalori, which is located in a highly volatile area of the state. Arriving with 300 doses of oral polio vaccine, and 200 doses of measles vaccine, he was told that new arrivals were expected later that day. Many of the people coming had been under siege by non-state armed groups since 2016, and had taken the opportunity of improved security and mobility to flee to the nearest town. Very few of the young children arriving had ever been reached with vaccines.
With the screening of children eligible for measles and polio vaccines starting around 9 am, and plenty more children yet to arrive, it was quickly clear that the available doses would not be enough.
Springing into action, Auta notified the head of the security team accompanying him of the need to go to nearest health facility to bring additional doses. Once clearance was given, he rushed to Jere Local Government, a district nearby, to collect more vaccines.
In the meantime, however, there were sudden changes in the security environment. The return journey to Dalori was not cleared until late noon.
Luckily, giving up isn’t in Auta’s nature.
By the end of the day, he had successfully delivered 580 doses of oral polio vaccine and 460 doses of measles vaccines for the children in the camp, providing some of them with their first ever interaction with a health system.
The crucial role of Vaccine Security and Logistics facilitators like Auta cannot be over-emphasized. In addition to his central work, Auta also conducts advocacy visits to traditional and religious leaders and supports the planning and implementation of vaccination campaigns in inaccessible areas.
Vaccine facilitation may be unpredictable work, but Auta is secure on one thing. Thanks to the work of him, and thousands of other determined health workers, community mobilizers and with support from donors and partners including the Bill & Melinda Gates Foundation, the Government of Canada, the Dangote Foundation, the European Union, Gavi – The Vaccine Alliance, the Government of Germany, the Government of Japan, the Japan International Cooperation Agency (JICA), Rotary International, the US Centers for Disease Control and Prevention, the World Bank and others, Nigeria is steadily on its way to being declared polio-free.
On top of the US$ 120 million committed in 2013, last year, HH Sheikh Mohamed bin Zayed pledged an additional US$ 30 million towards polio eradication, and the UAE is active on the ground in Pakistan through the UAE-Pakistan Assistance Program
UAE support also funded more than 5000 committed full-time vaccinators in highest-risk districts of Pakistan
Last year saw the lowest number of wild poliovirus cases in history (22 worldwide); Pakistan reported a 97 percent decline in cases between 2014 and 2017
GENEVA (16 April 2018) – The Global Polio Eradication Initiative (GPEI) announced today that the UAE has completed the US$ 120 million commitment made by His Highness Sheikh Mohamed bin Zayed Al Nahyan at the 2013 Global Vaccine Summit in Abu Dhabi.
“We thank the UAE for their long-term generous support and unwavering dedication to polio eradication, and particularly the personal commitment of His Highness Sheikh Mohamed bin Zayed Al Nahyan, Crown Prince of Abu Dhabi,” WHO Director General Dr Tedros Adhanom Ghebreyesus said. “This is the kind of support that will ensure we reach every last child to complete the job and to show the way to delivering health to all.”
Polio is a highly infectious disease that can cause lifelong paralysis, but it is entirely preventable with vaccines. Only three countries remain which have never stopped polio: Afghanistan, Pakistan and Nigeria. When the polio eradication effort was launched in 1988, 350 000 children were paralyzed by polio every year across 125 countries.
Polio eradication efforts have since made remarkable progress and there were only 22 cases in 2017 – the lowest ever recorded number. However, a number of key challenges remain. Reaching the most vulnerable children with the polio vaccine is hampered by a range of hurdles including difficult terrain, insecurity, and large-scale population movements.
Following the Global Vaccine Summit, the UAE expanded its role through the UAE Pakistan Assistance Program (UAE-PAP) to ensure that further gains would be made where it was needed the most. Through the “Emirates Polio Campaign” initiative, the UAE has helped drive on-the-ground eradication efforts within the most vulnerable communities in Pakistan.
Speaking about the UAE’s work, His Excellency Mohamed Mazrouei, Undersecretary of the Crown Prince Court of Abu Dhabi said: “The UAE’s pivotal role in eradicating polio completely is not limited to being a donor only, but extends to include its capacity to convene key groups and provide on-ground support to deliver vaccines in the highest risk areas of Pakistan.
“The UAE’s support – both as a leading donor and passionate advocate – has been critical for getting as close as we’ve ever been to making history by eradicating polio,” UNICEF Director of Polio Eradication Akhil Iyer said. “This is a gift not only to the children of Pakistan but to all future generations of children, everywhere, who are so close to the goal of being able to be born and be raised in a polio-free world.”
Dr. Chris Elias, President of the Global Development Program, Bill & Melinda Gates Foundation, said: “The UAE and His Highness Sheikh Mohamed bin Zayed Al Nahyan have shown an unwavering commitment to end polio, and we are delighted to partner with them in this effort. Without their involvement, achieving a record low number of polio cases in 2017 would not have been possible.”
The UAE is a longtime supporter of the polio eradication program. In addition to the US$ 120 million that His Highness Sheikh Mohamed bin Zayed Al Nahyan pledged in 2013, he pledged a further US$ 30 million to polio eradication, announced by Bill Gates at the Rotary International Convention in Atlanta, USA in June 2017. With additional commitments in 2011 and 2014, in total, the UAE has contributed US$ 167.8 million since 2011 to help end polio, with direct support to Pakistan, Afghanistan, Somalia, Ethiopia, Kenya, and Sudan.
About GPEI
The Global Polio Eradication Initiative (GPEI) is led by national governments and spearheaded by the World Health Organization (WHO), Rotary International, the US Centers for Disease Control and Prevention (CDC), and the United Nations Children’s Fund (UNICEF), with the support of the Bill & Melinda Gates Foundation. Since its launch at the World Health Assembly in 1988, the GPEI has reduced the global incidence of polio by more than 99%.
The GPEI receives financial support from governments of countries affected by polio, private sector foundations, donor governments, multilateral organizations, private individuals, humanitarian and non-governmental organizations and corporate partners. A full list of all contributors is available on the GPEI website, http://polioeradication.org/financing/donors/
We talk to Professor Rose Leke, Chair of the African Regional Certification Commission, to get her views on progress on the continent, and prospects for certifying the region polio-free in 2019.
Welcome to Poliopolis! You’ll spend the next 28 days in a container village to help us test a new polio vaccine. Poliopolis is equipped with all the amenities to make your stay comfortable: air-conditioned private rooms with workstations and sinks, a lounge area with a flat screen TV and foosball table, a fitness room with a variety of exercise equipment, and a bright, sunny dining area. Enjoy your stay!
Sounds like a scene from a science fiction story, right? But this is a real polio vaccine trial that took place in a parking lot at the University of Antwerp, Belgium in mid-2017. The study, funded by the Bill and Melinda Gates Foundation, evaluated two novel oral polio vaccine candidates. These vaccine candidates were developed by scientists from the US Centers for Disease Control and Prevention’s polio laboratory, the National Institute for Biological Standards and Control in the United Kingdom, and the University of California, in San Francisco, with support from the US Food and Drug Administration.
Once fully developed and tested, these new, more genetically-stable, live, attenuated vaccines will prove a critical resource to ensure global polio eradication.
Ondrej Mach of the WHO polio research team discusses why new inactivated polio vaccine solutions are needed for the post-eradication era. Why are we developing entirely new vaccines for a disease which will no longer exist?
Le jour se lève dans le district sanitaire de Bol, au Tchad, et la Dre Adele commence sa journée. Elle monte dans son canoë et, après avoir jeté un coup d’œil à sa carte, commence un long voyage sur les eaux du lac Tchad. Dans quatre à six heures, se frayant un chemin parmi les roseaux, elle aura atteint une île isolée où les enfants n’ont encore jamais été vaccinés.
La Dre Adele Daleke Lisi Aluma vit dans l’une des régions du monde où la vaccination est la plus difficile. Dans le district de Bol, 45 pourcent des enfants vivent dans des îles isolées et difficiles d’accès où les obstacles géographiques, la violence, l’insécurité et la pauvreté empêchent le plus souvent de prodiguer à la population les services de santé et les autres services publics.
Son travail consiste à surmonter ces obstacles en cherchant chaque enfant non encore vacciné, tout en mettant à profit son expérience pour que le programme fasse le meilleur usage des ressources en vue d’atteindre à chaque fois le plus d’enfants possible.
Un itinéraire à planifier
La première étape de chaque campagne consiste à planifier l’itinéraire. En étudiant les cartes, en en comparant les informations, la Dre Adele et son équipe s’efforcent de trouver la façon la plus efficace d’atteindre les nombreuses îles où les vaccinateurs doivent se rendre.
« L’équipe prévoit souvent ses campagnes lors du marché hebdomadaire, car on peut alors vacciner les enfants qui accompagnent leur mère pour l’achat et la vente des produits de base », explique-t-elle.
Afin que le vaccin soit mieux accepté, la Dre Adele et ses collègues téléphonent aux anciens et aux chefs de village quelques jours avant chaque campagne afin de leur expliquer pourquoi il est si important de se protéger contre la poliomyélite et les autres maladies évitables par la vaccination.
Cette approche permet d’accroître la portée du programme. Auparavant, les vaccinateurs parcouraient parfois de longues distances, pendant de nombreux jours, avant d’arriver sur des îles où se trouvaient en réalité très peu d’enfants. Cela entraînait des gaspillages, les vaccinateurs ne parvenant pas à maintenir, sur le trajet de retour, les vaccins à une température suffisamment froide pour qu’ils puissent profiter à d’autres enfants. Aujourd’hui, une meilleure planification et l’achat de réfrigérateurs solaires pour le stockage des vaccins contribuent à résoudre le problème.
« Pour tirer le maximum d’une session de vaccination, nous devons nous assurer que nos opérations sur le terrain soient efficientes et efficaces, en manquant le moins possible d’occasions », ajoute-t-elle.
Le lac Tchad n’est pas un plan d’eau dégagé : les voies navigables y sont entravées par des roseaux et des arbres et par la vie animale. Pour atteindre les îles, la Dre Adele utilise un canoë, naviguant adroitement dans ces eaux difficiles pendant plusieurs heures. Les équipes doivent faire preuve de la plus grande vigilance. Il leur faut avancer, maintenir les vaccins au froid et éviter les piqûres d’insectes, voire les rencontres avec les hippopotames.
Malgré ces difficultés, elle trouve son travail extrêmement gratifiant.
« À chaque fois que j’atteins un village isolé, je me sens plus motivée que jamais à poursuivre mon action. »
Opérationnelle dès son arrivée
Dès qu’elle est arrivée sur l’île, la Dre Adele commence à vacciner. La majorité des enfants qui vivent dans des villages insulaires isolés ont reçu moins de trois doses de vaccin antipoliomyélitique oral, et sont donc vulnérables face au virus. La Dre Adele s’efforce de protéger chacun d’eux.
Un membre de la famille proche de la Dre Adele a été touché par la poliomyélite et cette expérience est pour elle un véritable moteur. Auparavant, elle a participé à des campagnes de vaccination et à la surveillance épidémiologique de cette maladie en République démocratique du Congo et en Haïti, dans le cadre d’une carrière qui l’a menée partout dans le monde.
Des résultats tangibles
À chaque campagne, la Dre Adele vaccine des centaines d’enfants, mais recherche également des signes du virus.
Lors d’un récent déplacement dans les îles, elle et son équipe ont découvert un enfant atteint de paralysie flasque aiguë, un signe potentiel de poliomyélite, qui n’avait pas été signalé au réseau de surveillance de la maladie. Il s’est finalement avéré que l’enfant n’avait pas la poliomyélite, mais cet exemple montre que le programme doit absolument continuer d’intervenir dans ces zones difficiles d’accès, de vacciner les enfants et d’inciter les communautés à signaler tout cas présumé.
La Dre Adele contribue d’ores et déjà à renforcer la surveillance en formant les habitants de chaque village à reconnaître les signes d’un cas de poliomyélite potentiel.
Elle prévoit également de futurs déplacements : « Nous pensons revenir bientôt encadrer et accompagner les équipes de vaccination dans les zones insulaires. »
Ces efforts sont indispensables pour atteindre les communautés les plus isolées du lac Tchad.
Pour plus d’informations sur les femmes en première ligne de l’éradication de la poliomyélite (en anglais)
In March, the Afghanistan polio eradication initiative conducted its first nation-wide immunization campaign for polio eradication in 2018. In just under a week, around 70 000 workers knocked on doors and stopped families in health centres, city streets and at border crossings to vaccinate almost ten million children. What an incredible achievement.
But what does a huge campaign like this take?
We had a look behind the scenes and followed the week in Herat, western Afghanistan. See what the campaign looked like from beginning to end through this photo essay.
First there are the vaccines. Throughout the year, millions of doses of vaccines are stored in cold rooms across the country, ready to be used in immunization campaigns. Here, cold chain manager Ghulim Said shows oral polio vaccine vials − the primary vaccine used for polio eradication − which are stored in the Herat regional EPI vaccine storage facility.
Before each vaccination campaign, the polio programme draws detailed maps of where each team will head. These maps are called “microplans” and they show streets, landmarks and each house that vaccinators must visit during the campaign days.
A week before vaccination begins, polio workers start preparing. For this campaign, more than 70 000 volunteer vaccinators and other polio workers were selected and trained in vaccination, finger marking and campaign monitoring. In Herat, students Jami Mansoora (left) and Asma Hakimi (right) were trained as campaign monitors.
One day before the campaign, vaccines and other supplies were picked up from storages to be taken to the teams. These vaccines were taken from Herat regional hospital to a nearby district. They were kept in cold boxes to maintain vaccine quality.
To mark the start of the week-long effort, inauguration ceremonies were held across the country. Herat provincial governor Asef Rahimi vaccinated local children during one such ceremony.
On the first day of the campaign, banners were hung on roadsides, mosques, and health centres all over the country announcing the campaign and encouraging parents to vaccinate their children. This banner was hung on the side of a busy street in Herat city.
In the morning, the blue boxes used to keep vaccine vials cold were packed and picked up by the vaccination teams. Shireen Gul Azizi packed her bags before leaving for the day’s work. She works as a supervisor and manages three vaccination teams.
With the teams on their way, vaccination began. They walked from door to door, knocked and gave two drops of polio vaccine to every child they could find.
Ali Yaser, age 4, was vaccinated on the first day of the campaign in Herat city. All vaccinated children were also given drops of vitamin A to boost their immunity.
In addition to the house-to-house teams, mobile and transit teams worked across the country to reach any children on the move. At the border crossings, travellers were stopped and their children vaccinated. At these points, all children under ten years old are vaccinated. Mohammed Hussain Farhang, age 6, was returning from a holiday in Iran with his family. At Islam Qala border crossing vaccinator Bashir Ahmad gave him two drops of polio vaccine. He found finger-marking funny and couldn’t stop giggling.
During the campaign week, mobile teams also vaccinated children on the streets and outdoor markets. Farzad, age 16, was working by himself in the centre of Herat. In a single day, he vaccinated tens of children.
Every evening after the rounds, the vaccinators and cluster supervisors got together for a meeting to discuss any problems that might have been encountered during the day’s work.
On Thursday, three days into the campaign, the vaccinators took a break and collected numbers on how many children had not been home or had missed vaccinations for other reasons. Detailed plans were drawn and maps created showing each team which houses still needed to be revisited on the last day.
In some places, more vaccines were needed. Rickshaw driver Khalil Ahmad played his part in ensuring that every team had enough vaccines, driving more supplies to a neighboring district for the final revisit day.
On the morning of the last campaign day, cluster supervisor Ahmad Rashid examined his map to see where the five vaccinator teams he managed would be heading. He knew the revisit day was important during every campaign: this was the chance to reach every last child in his area.
One of Ahmad Rashid’s teams, vaccinators Sumaya Hakimi (left) and Sohaila Hamidi (right), started working at eight in the morning. From their maps they could see that they had missed 36 children during the week. By 11 a.m., they had already found 30 of the children at home and had vaccinated them.
Success! Moheburrahman, age 3, was not vaccinated earlier in the week when the team visited, as his mother was worried about the vaccine’s safety. The team talked with the family again, carefully explaining why the polio vaccine is so important, and taking time to discuss their concerns. Reassured that the vaccine is safe, little Moheburrahman’s mother allowed the vaccination to go ahead.
One last child protected against paralysis. Little one-day-old Fatima received her first ever vaccination on the last day. She could not be vaccinated earlier, as she had not been born yet.
After the campaign, more than 1 800 independent monitors were deployed to find any missed children and record the reason they were missed. This information will help preparations for the next campaign.
In a local health centre in Herat, Najibullah Mohammadi conducted a finger-marking survey to check if every child had a little blue pen mark on their fingers. On little babies the mark was drawn on the ear – an easy way to show they have been vaccinated whilst keeping them wrapped up warm. 45-day-old Rokshana was found to be vaccinated.
Rokshana and every child deserves a healthy, polio-free life. Thanks to the work of the thousands of volunteers and polio workers, Afghanistan is one step closer to eradicating the disease.
Zulaihatu Abdullahi is well known in her community, particularly to the mothers. As a volunteer community mobilizer in Kaduna state, northern Nigeria, her mission is to ensure that no child contracts polio, or any other preventable childhood disease.
This is difficult, as immunization programmes are sometimes treated with suspicion in her part of Nigeria. As a ‘change agent’, Zulaihatu’s job is to go door to door, counselling parents about the importance of the polio vaccine.
This particular lunchtime, she is visiting an 18 year-old mother living in a compound in a densely-populated, urban district of Kaduna State.
The young mother puts down the pole she is using to pound millet and welcomes Zulaihatu, recognising her royal-blue UNICEF hijab. She sits, and pulls on a hijab for cover as she settles down to breastfeed her baby. She has three other small children at home, a fifth on the way and she is new to the area.
“Before I came here I was rejecting all vaccines,” she says, “but because of this woman, Zulaihatu, I decided to accept. She told me the usefulness and I was convinced to do it.”
Thanks to Zulaihatu’s patience, and her work to build trust with the younger woman through regular visits, four more children are now protected against polio who might otherwise still be at risk. The mother has also been encouraged to seek anti-natal care, and the youngest child has just received his routine immunization shots.
“Sister Zulaihatu was one of the first women I met when we moved here,” the mother recalls. “She came here every day. She told me how she takes care of her own children. What she feeds them. How they all take vaccines. Little by little I started to change my thinking.”
Zulaihatu is trained to make her community aware of important household and parenting practices to keep their children thriving. The list is extensive and includes tips to treat diarrhoea, the importance of basic hygiene and sanitation, how to protect the family from malaria, the benefits of neonatal care and breastfeeding for infants, and the importance of registering their births.
She is one of nearly 20 000 UNICEF-trained community mobilizers, influencers and communication experts spread across 14 northern ‘high risk’ Nigerian states. With the support of donor and partners including the Bill and Melinda Gates Foundation, CDC, Dangote Foundation, European Union, Rotary, GAVI, JICA, the World Bank and the Governments of Canada, Germany, Japan, and others, the mobilizers are a key part of UNICEF’s ongoing support to the Government of Nigeria’s immunization programme.
Despite their achievements, Zulaihatu and other mobilizers know that there is much is still left to be done in their communities. Tomorrow, Zulaihatu will continue her work, going from household to household to keep every child safe.
Somalia, which stopped indigenous wild polio in 2002, is currently at risk of circulating vaccine-derived poliovirus type 2, after three viruses were confirmed in the sewage of Banadir province in January 2018. Although no children have been paralysed, WHO and other partners are supporting the local authorities to conduct investigations and risk assessments and to continue outbreak response and disease surveillance.
Underpinning these determined efforts to ensure that every child is vaccinated are local vaccinators and community leaders – nearly all of whom are women.
Bella Yusuf and Mama Ayesha are different personalities, in different stages of their lives, united by one goal – to keep every child in Somalia free from polio. Bella is 29, a mother of four, and a polio vaccinator for the last nine years, fitting her work around childcare and the usual hustle and bustle of family life. Mama Ayesha, whose real name is Asha Abdi Din, is a District Polio Officer. She is named Mama Ayesha for her maternal instincts, which have helped her to persevere and succeed in her pioneering work to improve maternal and child health, campaign for social and cultural change, and provide care for all.
Protecting all young children
Working as part of the December vaccination campaign, which aimed to protect over 700 000 children under five years of age, Bella explains her motivation to be a vaccinator. Taking a well-deserved break whilst supervisors from the Ministry of Health and the World Health Organization check the records of the children so far vaccinated, she looks around at the families waiting in line for drops of polio vaccine.
“I enjoy serving my people. And as a mother, it is my duty to help all children”, she says.
For Mama Ayesha too, the desire to protect Somalia’s young people is a driving force in her work. A real leader, she began her career helping to vaccinate children against smallpox, the last case of which was found in Somalia. Since then, she has personally taken up the fight against female genital mutilation, working to protect every girl-child.
She joined the polio programme in 1998, working to establish Somalia as wild poliovirus free, and ever since to oversee campaigns, and protect against virus re-introduction. In her words, “My office doesn’t close.”
Working in the midst of conflict
The work that Bella and Mama Ayesha carry out is especially critical because Somalia is at a high risk of polio infection. The country suffers from weak health infrastructure, as well as regular population displacement and conflict.
For Bella, that makes keeping children safe through vaccination even more meaningful.
“Through my job I can impact the well-being of my children,” she says. “For every child I vaccinate, I protect a lot more”.
Mama Ayesha echoes those words when she contemplates the difficulties of working in conflict. For most of her life, the historic district where she works, Hamar Weyne, has been affected by recurrent cycles of violence and shelling. With her grown children living abroad, she could easily move to a more peaceful life. But she chooses to stay.
“This is my home, and this is where I am needed. I am here for my team, and all the children.”
Looking up at a picture of her husband, who died many years ago, Mama Ayesha considers the determination and courage that drives her, Bella, and thousands of their fellow health workers to protect every since one of Somalia’s children. Behind her thick wooden desk, she is no less committed than when she began her career. “If I had to do it again it would be my pleasure.”
Bella has a similar professional attitude, combined with the care and technical skill that make her a talented vaccinator. Returning to her stand below a shady tree, she greets the mothers lined up with their children. As she carefully stains the finger of the first small child purple, showing that they have been vaccinated, she grins.
“I am the mother of all Somali children. I am just doing my job”.
When the sun rises in the health district of Bol, in Chad, Dr Adele’s day begins. Launching her canoe into the reed-filled waters of Lake Chad, and taking a look at the map, she readies herself for the long journey ahead. In four to six hours time she will arrive at a remote island, where there are children never before reached with vaccines.
Dr Adele Daleke Lisi Aluma works in one of the most challenging areas of the world in which to vaccinate. In Bol, 45% of children live on difficult-to-access, remote islands, where geographical barriers, violence, insecurity, and poverty mean people usually do not receive health or other government services.
Her job is to overcome these barriers, seeking out every last child for vaccination, whilst using her experience to ensure that the programme makes the best use of resources to reach the most children, every time.
Planning the route
A first step for every campaign is to plan the route. Studying maps, and comparing information, Dr Adele and her team find the most efficient way to reach the multiple islands that must be visited by vaccinators.
“The team often plans campaigns to take place at the same time as the weekly market, to vaccinate children when they are with their mothers buying and selling necessities,” she says.
To increase acceptance of the vaccine, a few days before each campaign, Dr Adele and her colleagues telephone village elders and leaders, explaining why protection against polio and other vaccine-preventable diseases is so important.
This helps to improve the programme’s reach. In the past, vaccinators sometimes travelled long distances over many days to islands where there are very few children. This meant wasted vaccine, as vaccinators were not able to keep the spare vaccines cold enough on the return journey to be used for other children. Today, better planning, as well as the purchase of solar refrigerators for vaccine storage, helps to solve this issue.
“To maximise a vaccination session, we need to make sure our field operations are efficient and effective, minimizing missed opportunities” she says.
Lake Chad is made up of waterways filled with reeds, trees, and wildlife: not a flat stretch of water. To get to the islands, Dr Adele uses a paddle canoe, deftly navigating the difficult terrain for hours at a time. The teams need to be careful – while steering straight and keeping the vaccines cold, they must also watch out for insect bites – and even hippos.
Despite the challenges, she finds a huge sense of achievement in her work.
“Reaching a difficult to access village gives me every time a sense of motivation to continue.”
Arrival
Upon reaching an island, Dr Adele begins vaccination. The majority of children in remote island villages have received less than three doses of oral polio vaccine, leaving them vulnerable to the virus. One by one, Dr Adele works to protect them.
Dr Adele is driven in her work by her experience of a close family member with polio. Previously, she conducted immunization and epidemiological surveillance for polio in the Democratic Republic of the Congo and in Haiti, as part of a career that has taken her all over the world.
The results
With each campaign, Dr Adele vaccinates hundreds of children, but she also looks for signs of the virus.
On a recent trip to the islands, she and her team discovered a child with acute flaccid paralysis, a potential signal of polio, who had not been reported to the polio surveillance network. While the child didn’t have polio, this underlines the crucial need for the programme to continue to access these difficult to reach places, vaccinate children, and encourage communities to report any suspected polio cases.
Dr Adele is already helping to strengthen surveillance through training community members in each village to recognise the signs of a potential polio case.
She is also planning her next journeys: “We plan to return soon to supervise and accompany vaccination teams in the island areas.”
To reach the remotest communities in Lake Chad, this is what it takes.
In eastern Afghanistan, one family is helping to vaccinate every last child in their community
Zahed, his daughter Sahar, and son Mohammad all work together. But they are not working for themselves, they are working to eradicate polio.
The family lives in an indigent village in eastern Afghanistan with a diverse community. It is close to the border with Pakistan and many residents are returnees from Pakistan, families displaced by insecurity and nomads passing through. With a population that is often on the move, it is a community with high risk of poliovirus transmission – making it extremely important to vaccinate every child.
Zahed’s family are well-known. Each month, they knock on doors giving free vaccinations and educating their community about the virus.
Although sometimes they don’t have doors to knock – only tents. Known in Afghanistan as Kuchis, nomads are particularly vulnerable to polio, because they move seasonally and often miss vaccination campaigns. Historically underrepresented and often neglected, they are also isolated from health services.
Nomads at risk
Laden with water jugs, cooking equipment and clothes, the Kuchi travel with their livestock and move between provinces depending on the climate. Their goats, sheep and camels are often exchanged or sold for grain, tents and other essential items. There are an estimated two million nomads in Afghanistan.
Over 120 nomad families with 194 children under the age of five recently arrived in Zahed’s village from shelters along the Kabul River. They come in the winter because it offers warmer, more fertile ground for their animals to graze. They return to Kabul and Bamiyan during the spring, when the land is more arable.
To eradicate polio in Afghanistan, every child must be vaccinated – including the nomads. And this is exactly what Zahed’s family are doing. They go to each tent, and ensure every child is protected against polio. Last week, Zahed’s 20-year-old son Mohammad vaccinated 719 children, including nomads. “My community are happy with my service. I’m young, and it is a privilege to make a difference,’’ says Mohammad.
The family is not only protecting children, they are also contributing to community cohesion and bridging divides between nomads and residents. The challenge, however, is continuing to vaccinate nomads when they are on the move.
The motivation of Zahed’s family is impressive, but it is not always easy. A handful of people in the village reject the vaccine because they think that it is unsafe or not halal – permissible in traditional Islamic law. But watching an entire family working to eradicate polio helps break misconceptions. At the start of each vaccination campaign, Mohammad gives one of his own children the vaccine to prove that it is safe.
Becoming advocates
Zahed’s family have turned almost all the families who were refusing the polio vaccine into advocates for vaccination. Mohammad was already a prominent member of the community and was previously given a ‘Turban’ – headwear used to recognize a person who makes decisions on behalf of their community and country – to honour his relentless work to improve water, sanitation and development in his village. Now his role as a polio eradication ambassador is developing trust and increasing acceptance of the vaccine.
In 2017, three polio cases and 14 positive environmental samples were reported in eastern Afghanistan. A positive sample indicates that the polio virus is present, and that children with low immunity are at risk of contracting the disease. The first polio case of 2018 was also reported in eastern Afghanistan, making it an urgent priority location for nationwide eradication.
In the village, polio has almost been eradicated. But this is not enough for Zahed’s family. As they prepare for their next vaccination round, they are determined not to stop their work until everyone in their community – wherever they are from – is safe from polio.
The discovery of wild poliovirus in Borno and Sokoto states in Nigeria in 2016 after more than two years without any reported cases prompted a multi-country response in neighbouring countries of the Lake Chad basin, covering Cameroon, Central Africa Republic, Chad, Niger and Nigeria. Since the outbreak response started, coordinated vaccination campaigns have been taking place in all five countries, reaching tens of millions of children. This year, campaigns are planned for March, April and October – all of them synchronized between the neighbouring countries.
In Chad, vaccination activities for polio and other diseases are being carried out in priority districts, supplementing regional campaigns which aim to target the hardest-to-reach children.
A child is vaccinated in a nomadic camp in the village of Ngouboua, in Chad’s north-west region. Additional vaccination activities have taken place in priority districts in Chad between regular campaigns to help strengthen the immunity of children under five.
Teams make dedicated efforts to reach children from difficult-to-access populations: particularly nomadic and island-dwelling families who are often not reached by routine health services, as well as returnee, displaced and refugee populations with limited access to regular vaccination.
Health centers in Chad’s 11 priority districts are supplied with routine vaccines including tuberculosis vaccine, polio vaccine, pentavalent, and measles vaccines, so that trained health workers can vaccinate all children from 0 to 11 months against vaccine-preventable childhood diseases, using fixed, advanced and mobile vaccination strategies.
Vaccinator teams use creative approaches to access hard-to-reach and at-risk populations. Children are being reached with polio and other critical vaccines through vaccinator outreach in areas including weekly markets, islands, and at refugee, displaced and returnee camps.
WHO, UNICEF and partners in the Bagasola district navigate through islands to deliver vaccines to the most vulnerable remote communities.
There are hundreds of islands within Lake Chad that are hardly accessible to health workers. Efforts to specifically reach these locations have been made a national priority.
The Blarigui community meets with the Canton (sub-region) Chief and the vaccination team responsible for the Reaching Every District strategy in the Bagasola region, prior to a special campaign in 2017.
In Chad, engagement of communities and their leaders is key to reaching every child. During immunization campaigns, social mobilizers and the community meet and discuss the importance of vaccination, a practice that has proven successful to increase trust among parents and communities towards vaccinators and campaigns.
Recommendations to bolster the multi-national regional outbreak response across the Lake Chad basin have highlighted the need to improve operations in hard-to-reach areas. In Chad, health workers have been trained to make better use of campaign micro-plans, which map the location of every household, and ensure that each is visited by vaccinators during a campaign. All under-fives living in the high-risk districts of the Lake Chad basin have also been recorded in an community register, helping to ensure that every child receives two drops of polio vaccine in each vaccination round.
More than 4.5 million children under five were reached through national vaccination campaigns in Chad in 2017. Among these, thanks to the renewed focus on identifying and reaching missed children, more than 215,000 were vaccinated from the priority districts of the Lake Chad basin region - particularly those who reside on difficult-to-access islands within the geographical boundaries of Nigeria.
A health worker provides a dose of pentavalent vaccine to a child during an outreach immunization session in Chad. As part of the intensive vaccination campaigns, teams are reaching children with more than just polio vaccine – bringing broader benefits to remote and hard-to-reach communities and maximizing the reach of the polio network.
A bold sign in the camp for internally displaced persons makes it clear where people can come to be vaccinated against yellow fever. WHO/NIGERIA
As he climbs out of his car and walks across to the entrance of Bakassi camp for internally displaced persons in Borno, northern Nigeria, Dr Terna Nomwhange is met by a familiar sight. Standing at the gates, greeting a tired, dusty family laden with possessions, is a team of polio vaccinators. As families arrive at this sea of shelters following a long, hard journey, these people offering polio vaccines are the first sign that they have reached a place of protection.
Not only are families in northern Nigeria facing insecurity, a humanitarian crisis and the threat of polio, but since September they have also been at risk from an outbreak of yellow fever. By early January 2018, a total of 358 suspected cases had been reported in 16 states, with 45 deaths recorded for 2017. In Borno, the ongoing conflict means that the health infrastructure on the ground to respond to the outbreak is limited to local government and the polio eradication infrastructure.
At the camp gates, the polio vaccinators give two drops of vaccine into the mouth of every child; but they also tell the parents where to go to get their yellow fever vaccination. As Dr Terna, who works for the WHO Nigeria polio eradication programme, walks further into the camp, he catches sight of the distinctive blue that signifies the uniform of a polio volunteer community mobilizer. As she emerges from the door of a shelter, he hears her reminding the family within to get their children vaccinated against polio, but also for the whole family to be vaccinated against yellow fever.
With weakened health system in parts of north eastern northern Nigeria, the infrastructure that is already on the ground to stop polio is providing the volunteers needed to support the yellow fever vaccination campaign. More than eight million people are being targeted with yellow fever vaccines in the states of Borno, Zamfara Kwara and Kogi states in 2018.
Vaccinating adults
By providing both polio and yellow fever vaccinations, the polio infrastructure protects everyone – the young children vulnerable to polio, as well as the whole population at risk of yellow fever. WHO/NIGERIA
Regular polio vaccination campaigns reach children under five years of age with polio vaccines, as this age group is the most vulnerable to the virus. But reaching everyone between nine months and 45 years to protect them against yellow fever takes creative thinking. People who would not usually be vaccinated have to be mobilised to come to health clinics where they can receive that one shot of yellow fever vaccine that infers life-long protection.
This is where the polio infrastructure comes in. To prepare for the launch of the yellow fever vaccination campaign that took place at the beginning of February, polio experts supported the preparations by developing detailed microplans, mapping each community so that every individual can be vaccinated. Volunteer community mobilisers, well versed in educating communities about the risks of infection, used their skills to warn populations of the high mortality rates associated with yellow fever.
Surveillance
Volunteer community mobilizers for the polio programme spread awareness of the importance of polio and yellow fever vaccinations. WHO/NIGERIA
The polio surveillance system in Borno is already on high alert to identify any case of polio, even in conflict affected areas. “Surveillance remains everyone’s number one priority,” says Dr Terna. “While the polio infrastructure is doing everything it can to find any trace of polio, it is killing two birds with one stone by keeping an eye out for yellow fever as well. This is a win-win situation to stop both diseases.”
While surveillance focal persons move house to house, they are also raising awareness about the symptoms of yellow fever. When a potential case is found, the polio infrastructure is being used to collect blood samples and transport them to the national laboratory down the reverse cold chain, keeping samples at the correct temperature for testing.
Collaboration
Volunteer community mobilizers for the polio programme spread awareness of the importance of polio and yellow fever vaccinations. WHO/NIGERIA
“What makes this campaign special is not just the fact that the strong polio infrastructure is helping to control other diseases, but also that it underscores what can be achieved with intersectoral collaboration and partnership,” said Dr Wondimagegnehu Alemu, WHO Country Representative to Nigeria. “Without the polio eradication infrastructure, a campaign of this scale would not have been able to take place.”
“Everyone is pulling in one direction – the government, partners and volunteers within communities – to protect any and every vulnerable person against polio and yellow fever,” says Dr Aliyu Shettima, Polio Incident Manager at the Emergency Operations Centre (EOC) in Maiduguri.
Support for immunization to the Federal Government of Nigeria through the World Health Organization is made possible by funding from the Bill & Melinda Gates Foundation (BMGF), Department for International Development (DFID), European Union (EU), Gavi, the Vaccine Alliance, Global Affairs Canada (GAC), Government of Germany through KfW Bank, Japan International Cooperation Agency (JICA), Korea Foundation for International Healthcare (KOFIH), Measles and Rubella Initiative (M&RI) through United Nations Foundation (UNF), Rotary International, United States Agency for International Development (USAID), United States Centers for Disease Control and Prevention (CDC) and World Bank.
Vaccinating every child, every time Haroon, 3, was vaccinated for the second time in two weeks. WHO / Tuuli Hongisto
In Afghanistan, frontline health workers explain to parents why the polio vaccine must be delivered multiple times
“It’s easy for the others, they are young and strong!” laughs Hamida. She has just climbed hundreds of steps to the top of a long and steep staircase on the side of one of Kabul’s many hills. Together with her colleagues Mohib and Khalid she works as a part of a polio team vaccinating children in their community. Today, the team started at 8 am, and they have now been walking up and down the hill for three hours. No wonder she is tired.
So far, the group has visited 50 families and vaccinated 110 children. They have 30 more to go today, and, in the next three days, they will visit a total of 233.
The team’s role is not only to vaccinate the children but to also to educate people about the life-saving polio vaccine and its importance. It is not always an easy job.
“Last time we visited was only two weeks ago, so some parents have been asking why we are visiting again. I have explained to everyone that the vaccine is beneficial for the children and that children need to be vaccinated every time we visit to be protected.”
It is the first day of a vaccination campaign, which aims to immunize over 6 million children against polio in Afghanistan.
Today, thankfully, all families have accepted the vaccine from this team.
Last push to eradicate polio in Afghanistan
Afghanistan is one of the last countries in the world where wild poliovirus still circulates, and has the highest number of children paralyzed by the virus.
In 2017, there were a total of 14 cases and, so far in 2018, there have been three confirmed cases. In recent months, the virus has been found circulating in southern and eastern regions.
WHO Afghanistan polio programme manager Dr Hemant Shukla is confident that with stepped-up efforts, the circulation can be stopped. “Afghanistan has stopped transmission in the past in all areas, but not at the same time. We are confident that by following correct strategies, focusing in the right areas and by coordinating our efforts with neighbouring Pakistan, we can stop the transmission”.
To answer to the challenge, the Polio Eradication Initiative has stepped up efforts to detect any viruses in the environment. The programme is taking special steps in the eastern and southern regions to reach all children with the vaccine every time the vaccinators pass by, as these are very high risk areas for polio transmission, with people moving in and out of neighbouring Pakistan. Special outreach tactics are concurrently aiming to reach and immunize ‘mobile populations’, such as nomadic people, who are at high risk of contracting polio.
The oral polio vaccine is effective as it not only protects children from contracting the virus, it also prevents them from carrying it in their intestines. Several doses – spaced apart – need to be given to build sufficient immunity, especially in areas where poor nutrition can weaken immune systems.
During the low transmission season, the Polio Eradication Initiative conducted two campaigns – in January and February – in order to vaccinate children in high risk and very high risk districts in quick succession so that the vaccine would have a maximum effect.
In March, 10 million children across the whole country will be vaccinated – that’s every single child under the age of five years.
In Kabul, one by one the team marks their tally sheet with numbers and ages of the children and takes note whether all the children of the household were present.
One of the children vaccinated today is three-year-old Haroon, who stands outside his family’s home. His mother Nadia peeks through the gate. She has six children, and Haroon is her youngest.
“Haroon was just vaccinated two weeks ago, but I know it is important to vaccinate children every time”.
The team marks this household vaccinated for today.
In four weeks, Nadia will open up her door when the vaccinators knock again.
In Nigeria’s north-eastern Borno state, children displaced by ongoing conflict are being reached with essential immunization and health care services, thanks to a strong network of Volunteer Community Mobilisers established by the polio eradication programme.
Two-year-old Hafsat Khalifa waits patiently in line with her mother, Hadiza. Hadiza is one of many women who’ve brought their young children to receive vital immunization at the local health camp in Maiduguri. Hafsat knows she needs to open her mouth wide when it’s her turn to receive the oral cholera vaccine just like she did when vaccinated with the Oral Polio Vaccine. She displays the confidence of a seasoned pro, although in reality this is the first year she has received any health services, having been born into an area of conflict. Along with these two vaccines, Hafsat will receive other much-needed health care during today’s visit.
Humanitarian crisis
Hafsat is one of many thousands of children affected by the humanitarian crisis in north-eastern Nigeria. The conflict has resulted in a surge in internally displaced persons, with limited access to medical care, leaving millions at risk of life-threatening diseases. Since four cases of wild poliovirus type 1 were detected in Borno in August 2016, an outbreak response for polio has been a top priority. But it has been carried out hand in hand with broader humanitarian efforts to meet the health needs of vulnerable populations.
Benefits beyond polio eradication
UNICEF’s vast network of volunteer community mobilisers have not only played a vital role in ensuring that children like Hafsat receive OPV and other health services every time they are offered, but are leveraging the skill-set they’ve gained from their expanded training to impact child and maternal health far beyond polio.
In addition to receiving the oral cholera vaccine today, Hafsat’s nutrition status will be assessed at the health camp, and children identified as malnourished will be referred for receiving therapeutic food. This important network of polio vaccinators, with years of experience in reaching children with polio vaccines, has made a huge difference in halting the spread of cholera and meningitis outbreaks in Nigeria in 2017. They are also helping create awareness and generate demand for the upcoming campaign against measles.
The reach of this network even extends to protecting children before they are born. Volunteer community mobilisers provide critical antenatal care for pregnant women that can save the lives of mothers and babies alike. And this year, for the first time ever in an emergency humanitarian setting, antimalarial medicines have been delivered on a mass scale alongside the polio vaccine, reaching 1.2 million children in a campaign in August.
For families in Nigeria’s north-east, many who have fled their homes in the face of ongoing violence, this life-line to access essential services is critical to ensuring their children can grow up protected from vaccine-preventable diseases.
Anytime a child is paralyzed by polio in any country, the World Health Organization and its partners move fast to stop the outbreak.