GPEI-Pakistan polio infrastructure continues support to flood relief, while intensifying eradication efforts

As Pakistan continues to struggle from the effects of the devastating floods affecting parts of the country, polio staff on the ground continue to assist emergency relief efforts.

In flood-affected districts, the polio effort is supporting establishment of critical health camps, to provide basic clinical services, particularly ensuring treatment of water-borne and vector-borne diseases, and distributing water purification tablets. All routine immunization antigens are also provided to target children and pregnant women. Staff are actively conducting surveillance for communicable diseases, identifying nutrition needs of displaced populations, and collecting and analysing life-saving data to help target response strategies. Polio programmes around the world have a long history of supporting broader public health and humanitarian emergencies, as was the situation earlier this year in Afghanistan, following the devasting earthquake there.

At the same time, the polio programme is adapting its operations, to ensure polio eradication efforts can continue unabated, even amid the tragedy. The programme is at a critical juncture – intensive response is ongoing to stop this year’s outbreak in southern Khyber Pakhtunkhwa. Virus linked to this outbreak was this month detected in an environmental sample from Karachi, in the south of the country. At the same time, the high transmission season for polio transmission is now starting and this transmission risks being particularly intense given the floods.

But despite these challenges, polio staff are working double-time: adapting polio approaches, while supporting life-saving flood relief efforts.

“I have been fortunate enough to be present when a number of countries successfully eradicated polio,” commented Dr Hamid Jafari, Director for Polio Eradication at the World Health Organization’s Regional Office for the Eastern Mediterranean. “Rarely have I seen such commitment and dedication than I have seen in Pakistan – from national political leaders, to health workers, right to the mother and father on the ground. To all who are involved, all I can say is: Thank you! You are making a huge difference to people’s lives, which goes far beyond the effort to eradicate polio.”

While detection of virus in Karachi is not unexpected, given the large-scale and frequent population movements between Karachi and the rest of the country, in particular Khyber Pakhtunkhwa. urgent efforts are underway, coordinated by the national and provincial Emergency Operations Centres (NEOC and PEOC), to continue surveillance efforts in greater Karachi and further boost immunity levels through health camps, to prevent polio from establishing a foothold in Pakistan’s largest city which has historically been a major polio reservoir.

Despite the extraordinary climatic conditions and consequent operational challenges aggravated by the collapse of infrastructure, the programme continued with the August polio campaign – including across Karachi – and re-adjusted the schedule in all accessible areas. While the immunization campaign could not be conducted in Balochistan and parts of Sindh, the effort managed to reach nearly 32 million children in the country, with health workers wading through deep water to reach children with the life-saving vaccine.

At the same time, the programme has undertaken contingency planning to resume intensified vaccination activities in southern Khyber Pakhtunkhwa to stop the outbreak, as soon as the situation allows. The programme continues to innovate, adapt, and find opportunities to build children’s immunity through vaccination at health camps, at transit points, in settlements for displaced persons.

And, of course, national and subnational authorities are coordinating activities with neighbouring Afghanistan, particularly in border regions, given that both countries represent a single epidemiological block. Confirmation this month of Afghanistan’s second case this year, from Kunar province, confirms the risk any residual transmission on either side of the border continues to pose to children across this block.

Kunar, along with the rest of the country’s Eastern Region, is part of one of three, critical cross-border epidemiological corridors with Pakistan, the northern corridor specifically comprising of Eastern Region and central Khyber Pakhtunkhwa in Pakistan. Case response is currently being planned in the immediate area and the broader corridor. The other two cross-border epidemiological corridors are the southern corridor, comprising Quetta Block of Pakistan and Southern Region, Afghanistan; and, the central corridor, comprising southern Khyber Pakhtunkhwa and South-East Region in Afghanistan.

Districts along the border of Pakistan and Afghanistan in the three epidemiological corridors are at high-risk for poliovirus transmission, given the high proportion of zero-dose children and inconsistent quality of polio vaccination campaigns in some areas.

The Pakistan and Afghanistan polio programmes continue to coordinate on surveillance and vaccination activities through the Global Polio Eradication Initiative Support Hub, based in Amman, Jordan.

A polio worker administers the oral polio vaccine to a child in Karachi. Credit: @SalmanMahar

Polio is one of the world’s most devastating diseases. It mainly affects children under five and in one in 200 cases it results in lifelong paralysis. Amazing progress has been made in fighting polio globally: according to UNICEF, there were a reported 20,000 children paralysed by polio in Pakistan in 1994. By 2021, new paralysis cases had dropped to just one child. However, as long as just one child remains infected, all children are at risk.

Identifying and reaching unvaccinated children has been a challenge, but big data startups like Zenysis, in partnership with Pakistan government partners, are making inroads.

Vaccination data is only useful if it’s accurate

Abid Hasan is the project manager for Zenysis – a Gavi INFUSE pacesetter since 2017 – in Pakistan, and he explains the barriers to a more effective vaccination programme in the country:

“Data is like people, in that if data sets don’t talk to each other then they won’t work well. Zenysis gets data and data sets talking.”

Community health workers employed through Pakistan’s Polio Eradication Programme and the Expanded Programme of Immunisation go door to door to collect vaccination data, sometimes using datasheets, sometimes paper, sometimes recording data through WhatsApp. It can be difficult to track families with no formal address, or mobile communities with no fixed address. With 14 million children requiring a polio vaccination every two months, recording accurate data is a mammoth task.

The resulting data can be imperfect, with duplication a particular challenge. This is where Zenysis’s platform comes in. Zenysis software integrates, de-deplicates and harmonises more than 20 siloed datasets, including polio data, immunisation registries and population data.

Combined, the data can be used far more effectively for analysis and, importantly, action on the ground. The result? A new and improved vaccination plan, personalised for each vaccinator’s district – known as a microplan.

A Community Health Worker goes door to door during the August polio campaign to give children the oral polio vaccine. She finds a newborn zero-dose child and records that data into her register. Credit: @SalmanMahar — A Community Health Worker goes door to door during the August polio campaign to give children the oral polio vaccine. She finds a newborn zero-dose child and records that data into her register.
Credit: @SalmanMahar

Microplans help health workers target zero-dose children

The enhanced microplans provide health workers with granular information on each child in a region, including their vaccination status, age and address. This information can be used to identify individual children and highlight neighbourhoods where there are clusters of unvaccinated (zero-dose) children. This in turn means better use of time and energy, and better outcomes for communities.

The effect, explains Hasan, is seen in three key areas. “Firstly, the newmicroplans give community health workers the real picture. Second, frontline workers now have a plan to follow and are no longer using broad or inflated data that is hard to actionize. Third, this approach is measurable – when you reach a target, that goes into the system. With accurate data, you can really see the impact.”

Health workers on the ground have seen the difference. Sadaf, a community health worker for Polio, in Karachi, says: “Before the microplans the vaccinators were given a long list of children with duplicate entries in them, and they were extremely difficult to track. After receiving these microplans we can easily decide where to set up our outreach sites and mobilise children to bring them there for vaccination in a systematic manner.”

The impact has been impressive. Since January 2022, the Expanded Programme on Immunisation in the Sindh region has used the Zenysis platform to identify over 28,500 true zero-dose children in the region and vaccinate 12,724 of them with the aid of microplans. In March to June of this year, 3,854 zero-dose children were vaccinated with the help of the new microplans in the regions where they have been implemented.

Community Health Workers using Zenysis provided microplans to identify houses with zero-dose children in high risk areas of Karachi. Credit: @SalmanMahar — Community Health Workers using Zenysis provided microplans to identify houses with zero-dose children in high risk areas of Karachi.
Credit: @SalmanMahar

Gavi support has been vital in creating goals and driving change

Zenysis was part of Gavi’s INFUSE programme, which connects high-impact innovations with the countries that need them most. Hasan explains that for countries like Pakistan, the investment from Gavi is vital to enhance healthcare budgets, but also to help provide momentum and set goals for vaccination programmes.

Looking ahead, Zenysis is collaborating closely with government partners to expand the platform and vaccination approach throughout Sindh province, tackle other vaccine-preventable diseases, and improve the government’s technical platform management capacity.

As Hasan says, “Not everyone is a data expert – but if you can go on a platform, go into a dashboard, and see all your data into one workspace then you can reach a zero-dose child and their family, and get them vaccinated.”

And with each child vaccinated, we get a step closer to a world where infection by wild poliovirus is a thing of the past.

Reposted with permission from gavi.org

Examining Terms of Reference for AFP Focal Points. ©WHO

Monday 6 June

Arrive Kabul at 9.30am, my first visit in two years and the city has lost none of its bustle.

A review team last visited here in 2016 but access was limited. Much has changed – both within Afghanistan and for polio – since then. The programme now has access across the country and the epidemiological picture has changed dramatically. In 2020, 56 children were paralysed by the virus. So far this year only one child has been paralysed giving Afghanistan its strongest chance yet of interrupting polio transmission.

Surveillance underpins the eradication of any virus. For polio, it consists of monitoring for signs of Acute Flaccid Paralysis or AFP in children under 15 years, and collecting samples of sewage, what we call environmental surveillance, to check for the presence of the virus in the community.

We’re here to apply a magnifying glass to Afghanistan’s surveillance system, to see if there’s anywhere the virus might still be hiding and recommend adjustments to make sure the system is capable of catching it.

If polio surveillance is about gathering data and documenting it meticulously, it’s even more so for a surveillance review. Our job includes checking documents and records, interviewing health workers and families of children with AFP, reviewing guidelines and standard operating procedures – checking and rechecking data.

Wednesday 8 June

Dr Abdinoor reviewing documents at a health facility. All major health facilities in Afghanistan have an AFP focal point who acts as the link between the facility and the broader polio surveillance system. © WHO

After meetings yesterday, including briefing the National Emergency Operation Center (EOC), the operational heart of the polio programme here, I head to Herat in the country’s west where my first stop is the WHO office. I meet the polio team before moving on to the Regional EOC where we discuss the objectives of my mission. I review records before checking the cold room where vaccines are kept. There’s a corner for stool specimens that come in from the western region. Part of the process of checking children with signs of AFP is collecting stool samples that are then sent to the regional laboratory in Pakistan for testing. Reviewing the collection, storage and shipping of these samples is part of my remit as a reviewer.

Thursday 9 June

At a hospital in Herat city, I meet with the AFP focal point – a pediatrician. All major health facilities have an AFP focal point who acts as the link between the facility and the broader surveillance system. I ask him about his background, the facility’s stool handling, preparation and shipment, and the work of the hospital.

In the afternoon, I examine two children affected by AFP earlier in the year. I talk to their parents and ask them the same questions they were asked by the initial investigating surveillance officer. I do this to check the accuracy of the information collected during the original case investigation and to see if there are any discrepancies.

Friday 10 June

Friday – the only holiday of the week. I spend it at the WHO office going through documents including AFP case files and data. It’s also a good opportunity to enter all the information I collected over the previous two days into the online tool developed specifically for this review.

Saturday 11 June

We set out early to a district near the border with Iran, two hours’ drive away. First stop is a very busy Comprehensive Health Center (CHC). It’s reported six out of the eight AFP cases from this district this year. I meet with the director, doctors, nurses, and other staff. Beneath their facemasks, their smiles are beaming. They speak with pride of their clinic and, like all the health facilities I visit, it’s spotlessly clean.

In the afternoon, I meet with the community health supervisor who oversees 16 community health workers (CHWs) working in village health posts nearby. Village health posts play an important role in community-based polio surveillance. I review the curriculum and training agenda to check what information is captured.

Sunday 12 June

I spend the day in the districts surrounding Herat city. My meetings include a visit to a traditional healer who fixes broken bones among other ailments, and a CHW who is an imam at a local mosque. Both are reporting volunteers in the 46,000-strong community-based surveillance network that keeps an eye out for polio among their communities.

Going through referral notes. The 16-strong review team visited 67 districts in 25 of Afghanistan’s 34 provinces, checking documents and records, interviewing health workers and families of children with AFP, and reviewing guidelines and standard operating procedures. © WHO

Monday 13 June

I visit an environmental surveillance site in Herat city. Samples are taken from sewage on a regular basis and shipped to the lab in Pakistan to determine the presence of poliovirus. I assess the site to see if it meets quality standards, check its location to make sure it’s in the right place to catch a good enough sample, the flow of the water and its appearance. I watch as trained staff from the local municipality collect a sample to determine whether the SOPs are adhered to.

Tuesday 14 June

To neighbouring Farah province, a round trip of about eight hours. At a CHC, a boy is brought in who was referred by a local faith healer. I observe the staff examine the child, and then visit the faith healer who tells me he inherited the knowledge of healing from his father and has been doing it now for over 20 years. It was heartening to hear him talk of his collaboration with the polio team for both AFP surveillance and immunization campaigns.

Wednesday 15 June

Last day in Herat city and I debrief the team in the REOC. Our flight back to Kabul departs late and we stop in Bamyan in the central highlands to collect two other passengers, including my fellow reviewer assigned to the Central Region.

The rest of the review team makes its way back to Kabul in the remaining days. We’ve all been doing the same thing – verifying, checking, interviewing, collating data. Our next task is to compile our report and provide any recommendations to the programme to make sure Afghanistan’s polio surveillance system catches every last virus, no matter where it may be hiding.

In 2021, when the news of cancer hit, Nomina Akhtar felt her world collapsing. It was discovered too late. By the time she knew, it was already stage-3 breast cancer.

Since 2015, Akhtar has been part of Pakistan’s polio programme as a community health worker. During these six years, she has found friends and well-wishers among her team members who have given her the support to carry on.

Akhtar, 43 and a mother of three continues to work for polio eradication as she undergoes treatment for cancer. “I gathered my courage and promised that I will fight till the end and live for my children. All my family, colleagues and seniors were with me whenever I needed support. That gave me courage and made me believe that I could, in fact, beat cancer.”

Based in Peshawar, Nomina’s husband and her three children, aged six, seven and 18, rely solely on her income. The lockdowns due to the pandemic caused her husband, a motorcycle mechanic, to close down his shop that has yet to reopen.

A life with cancer has been both physically and emotionally exhausting. She is undergoing both radiation and chemotherapy in Peshawar. This means a commute of almost 20 kilometers after a whole day of work.

“When I have to go for chemotherapy after work, it becomes very draining. I have to take public transport and wait at the hospital for hours. There are times when I have to return without treatment because either the machine is faulty or something else comes up. This treatment regime along with the medicine will continue for at least five years. It’s excruciatingly painful,” she says.

Polio programme: a great source of strength for Akhtar

“My colleagues are like my extended family, and I am like a sister to them. When I found out about my cancer, they wept with me. They have stood by my children and myself every step of the way.”

The supervisor of her area, Uzma Mansoor, says that when they first heard the news, they were devastated. “But it’s great to see that she has not lost hope and is fighting the disease like a champion,” she said.

The community she works in has also been incredibly supportive. “Some of the people in my work area came to know about my illness and they appreciated the fact that despite fighting cancer, I come to their doorstep during every polio campaign. Irrespective of extreme temperatures and illness, I am there to vaccinate their children and protect them from this life-threatening disease. Their support has increased manifold after this.”

Sahibullah, the Union Council Polio Officer of her area, says not only does Nomina continue to vaccinate children, but she is a role model for all other polio workers.

“It was God’s will, and we will face it with courage,” says her husband Aurangzeb Akhtar. “Despite being ill, Nomina is the one who keeps us going. She is working and earning for our family as well as motivating us to not lose hope. My children and I are so proud of her. Inshallah she will get well very soon.”

Nomina has strong conviction. She is fighting cancer and polio simultaneously, and is determined that she will defeat both very soon. “At least cancer has treatment,” she says. “Polio is incurable and the sooner we end this disease forever, the better.”

By Mohammad Shoaib,
Provincial Communications Officer KP, WHO Pakistan

A child is vaccinated during a nationwide vaccination campaign in Jabuary 2022. Seven national and one sub national campaigns have taken place since 15 August last year. © WHO/Afghanistan

Wild poliovirus transmission in Afghanistan is currently at its lowest level in history. Fifty six children were paralysed by wild polio in 2020. In 2021, the number fell to four. This year to date, only one child has been paralysed, giving the country an extraordinary opportunity to end polio.

The resumption of nationwide polio vaccination campaigns targeting 9.9 million children has been a critical step. Since 2018, local-level bans on polio vaccination activities in some districts controlled by the Taliban had significantly reduced the programme’s ability to vaccinate every child across the country. With access to the entire country following the August transition, seven nationwide vaccination campaigns took place between November 2021 and June 2022, and a sub national campaign targeting 6.7 million children in 28 provinces took place in July. Of the 3.6 million children who had been inaccessible to the programme, 2.6 million were reached during the November, December and January campaigns. With improved reach to previously inaccessible children throughout the February to July campaigns, the number children has been reduced to 0.7 million. Further campaigns are planned for the remainder of the year.

With Afghanistan and Pakistan sharing one epidemiological block, the two countries continue to coordinate cross border activities. December and May’s campaigns were synchronized with Pakistan’s national campaigns, focusing on high risk populations including nomadic groups, seasonal workers and communities straddling both borders.

Improved access also had a significant impact on polio surveillance activities. Afghanistan’s surveillance indicators remained above global standards throughout the transition. With access to all districts since August, the quality of activities has improved significantly including early case detection and reporting.

In June, the first review of the polio surveillance system in six years took place with WHO hosting a team of technical experts including epidemiologists and virologists. A small team visited in 2016 but insecurity and lack of access to much of the country limited the visitors’ movements to Kabul, Herat, Kandahar, Jalalabad, Mazar-e-sharif and Kunduz. This year, the 16-strong team visited 76 districts across 25 of the country’s 34 provinces. The review determined the likelihood of undetected poliovirus transmission in Afghanistan to be low. Recommendations, including upscaling surveillance in the country’s south and south east, are being implemented.

With more than twenty years on the ground in Afghanistan, the polio programme continues to leverage its extensive operational capacity to deliver better health outcomes for all Afghans. In the face of an unprecedented humanitarian crisis, in addition to day-to-day polio activities, polio staff continue to regularly monitor the functionality of health facilities across the country as well as support ongoing vaccination campaigns including measles and COVID 19. WHO’s polio team in the southeast were among the first responders following the devastating earthquake in Paktika and Khost provinces in June. In addition to providing critical health care, the team’s experience working among local communities provided the foundations of an assessment tool that mapped affected communities and ensured accurate data guided a focused response in the immediate aftermath.

Although the number of children paralysed by polio has reduced significantly in Afghanistan, the threat is far from gone and the programme faces significant challenges. While access has improved across the country, accessing every child though house to house vaccination remains a challenge in some areas leaving immunity gaps and, with them, children at risk.

On 24 February, eight polio workers were killed in targeted attacks in the country’s north, not the first time polio workers had come under attack in the course of their life saving work. Four of those killed were women. Female polio workers play a critical role in the programme, building community trust and reaching all children.

The sharp rise in the number of wild polio cases in Pakistan is a cause for concern, and the detection of one case each in Malawi and Mozambique is a reminder of the continued risks of poliovirus and the urgencyrequired to permanently interrupt transmission in both Afghanistan and Pakistan.

While the polio programme has made important progress in the last 12 months, sustaining those gains with high quality campaigns that vaccinate all children and build enough immunity to end circulation of the virus for good is critical. A polio free Afghanistan is within reach – but there is still a long way to go.

Emergency health centres provide the most urgent medical support to families © WHO

When disaster strikes, co-ordination is key. Within hours of the 5.9 magnitude earthquake striking the communities of Afghanistan’s South East in the early morning of 22 June, WHO’s polio team was on the ground joining forces with UN agencies and NGOs to ensure an effective and coordinated relief effort.

As dawn broke across the provinces of Paktika and Khost, and the extent of the devastation became evident, polio teams worked across both provinces to establish communications and share reports of the length and breadth of the destruction.

The team’s invaluable experience and local knowledge gained from more than two decades working among local communities in both Paktika and Khost provided the foundations of an assessment tool to map communities and assess the number and extent of casualties as well as the destruction to homes and buildings. This ensured accurate data guided a focused response in the immediate aftermath including the rapid construction of tents for shelter as well as housing ad hoc health camps.

Helping clear rubble following the devastating earthquake © WHO

In the districts of Giyan, Geru and Barmal in Paktika, polio teams assisted in attending the injured, providing trauma care and dressing wounds. One team member was despatched to Spera district in neighbouring Khost province to assist with trauma care.

Polio teams turned a helping hand wherever needed including digging for survivors, building tents, unpacking trucks and distributing shipments of WHO emergency and surgical kits, medical supplies and equipment, and the heartbreaking task of preparing and assisting in transporting the dead for burial.

With the very real risk of increased communicable diseases in the wake of any natural disaster, polio staff drew on the polio surveillance system to strengthen post-earthquake surveillance for acute watery diarrhea, measles, tetanus and COVID 19.

Emergency provision of trauma care. © WHO

More than 1,000 people died in the quake and nearly 3,000 were injured; homes buildings and livelihoods have been destroyed. The polio team will continue to work as part of WHO Afghanistan’s earthquake response including providing trauma care, physical rehabilitation and disability assistance.

The earthquake struck five days before the start of the fifth nationwide polio vaccination campaign for 2022. The campaign was postponed for one week in Paktika province and in Spera district of Khost province and will begin on 4 July.

Children show their inked fingers - a sign they have been vaccinated against polio. © WHO/Afghanistan — Children show their inked fingers – a sign they have been vaccinated against polio. © WHO/Afghanistan

Leaders at this week’s G7 Head of State meeting in Germany and last week’s Commonwealth Heads of Government meeting in Rwanda renewed global commitment to polio eradication. In their official Communiqué, the Leaders of the Group of Seven (G7) vowed to ‘continue our support for polio eradication through the Global Polio Eradication Initiative’, while the Commonwealth Heads of Government, in their joint Communiqué on ‘Delivering a Common Future’, urged the continued intensified effort to eradicate polio, even amid other pressing health and development issues. These calls and commitments follow similar engagements made at previous global political fora this year, notably the recently-held G7 Development and Health Ministers meeting, and the World Health Assembly.

Global partners of the eradication effort, notably led by Rotary International and Rotarians around the world, are working with the public sector to ensure political commitments are fully operationalized.

In April 2022, GPEI partners, led by WHO Director-General, launched the ‘Investment Case for Polio Eradication’, the sister document to the Polio Eradication Strategy 2022-2026, which lays out the economic and humanitarian rationale for investing in a polio-free world, as well as the broader benefits of polio eradication.

In October 2022, Germany will generously co-host a global pledging moment, giving the international development community and polio-affected countries the opportunity to publicly re-commit to this effort, including to support a stronger and sustainably-funded WHO, so that the organization can maintain its capacity to support countries in achieving and sustaining polio eradication, and continue to benefit broader public health efforts, including support for pandemic preparedness and response.

GENEVA, 26 April 2022

Today, the Global Polio Eradication Initiative (GPEI) announced that it is seeking new commitments to fund its 2022-2026 Strategy at a virtual event to launch its investment case. The strategy, if fully funded, will see the vaccination of 370 million children annually for the next five years and the continuation of global surveillance activities for polio and other diseases in 50 countries.

During the virtual launch, the Government of Germany, which holds the G7 presidency in 2022, announced that the country will co-host the pledging moment for the GPEI Strategy during the 2022 World Health Summit in October.

“A strong and fully funded polio programme will benefit health systems around the world. That is why it is so crucial that all stakeholders now commit to ensuring that the new eradication strategy can be implemented in full,” said Niels Annen, Parliamentary State Secretary to the Federal Minister for Economic Cooperation and Development, Germany. “The polio pledging moment at the World Health Summit this October is a critical opportunity for donors and partners to reiterate their support for a polio-free world. We can only succeed if we make polio eradication our shared priority.”

Wild poliovirus cases are at a historic low and the disease is endemic in just Pakistan and Afghanistan, presenting a unique opportunity to interrupt transmission. However, recent developments, due in part to impacts of the COVID-19 pandemic, underscore the fragility of this progress. In February 2022, Malawi confirmed its first case of wild polio in three decades and the first on the African continent since 2016, linked to virus originating in Pakistan, and in April 2022 Pakistan recorded its first wild polio case since January 2021. Meanwhile, outbreaks of cVDPV, variants of the poliovirus that can emerge in under-immunized communities, were recently detected in Israel and Ukraine and circulate in several countries in Africa and Asia.

The investment case outlines new modelling that shows achieving eradication could save an estimated US $33.1 billion this century, compared to the price of controlling polio outbreaks. At the launch event, GPEI leaders and polio-affected countries urged renewed political and financial support to end polio and protect children and future generations from the paralysis it causes.

“Despite enormous progress, polio still paralyses far too many children around the world – and even one child is too many,” said UNICEF Executive Director Catherine Russell. “We simply cannot allow another child to suffer from this devastating disease – not when we know how to prevent it. Not when we are so close. We must do whatever it takes to finish the fight – and achieve a polio-free world for every child.”

“The re-emergence of polio in Malawi after three decades was a tragic reminder that until polio is wiped off the face of the earth, it can spread globally and harm children anywhere. I urge all countries to unite behind the Global Polio Eradication Initiative and ensure it has the support and resources it needs to end polio for everyone everywhere,” said Hon. Khumbize Kandodo Chiponda MP, Minister of Health, Malawi.

The new eradication strategy centres on integrating polio activities with other essential health programs in affected countries, better reaching children in the highest risk communities who have never been vaccinated, andstrengthening engagement with local leaders and influencers to build trust and vaccine acceptance.

“The children of Pakistan and Afghanistan deserve to live a life free of an incurable, paralyzing disease. With continued global support, we can make polio a disease of the past,” said Dr Shahzad Baig, National Coordinator, Pakistan Polio Eradication Programme. “The polio programme is also working to increase overall health equity in the highest-risk communities by addressing area needs holistically, including by strengthening routine immunization, improving health facilities, and organizing health camps.”

The investment case outlines how support for eradication efforts will enable essential health services in under-served communities and strengthen the world’s defences against future health threats.

Since 2020, GPEI infrastructure and staff have provided critical support to governments as they respond to the COVID-19 pandemic, including by promoting COVID-safe practices, leveraging polio surveillance and lab networks to detect the virus, and assisting COVID-19 vaccination efforts through health worker trainings, community mobilization, data management and other activities.

“The global effort to consign polio to the history books will not only help to spare future generations from this devastating disease, but serve to strengthen health systems and health security,” said Dr. Tedros Adhanom Ghebreyesus, WHO Director-General.

Additional quotes from the GPEI Investment Case:

“We have the knowledge and tools to wipe polio off the face of the earth. GPEI needs the resources to take us the last mile to eradicating this awful disease. Investing in GPEI will also help us detect and respond to other health emergencies. We can’t waver now. Let’s all take this opportunity to fully support GPEI, and create a world in which no child is paralyzed by polio ever again,” said Bill Gates, Co-chair, Bill & Melinda Gates Foundation.

“An investment in polio eradication goes further than fighting one disease. It is the ultimate investment in both equity and sustainability – it is for everyone and forever. An important component of GPEI’s Strategy focuses on integrating the planning and coordination of polio activities and essential health services to reach zero-dose children who have never been immunized with routine vaccines, therefore contributing to the goals of the Immunization Agenda 2030.” said Seth Berkley, Chief Executive Officer, Gavi, the Vaccine Alliance.

“Twenty million people are walking today because of polio vaccination, and we have learned, improved and innovated along the way. We are stronger and more resilient as we enter the last lap of this marathon to protect all future generations of the world’s children from polio. Please join us; with our will and our collective resources, we can seize the unprecedented opportunity to cross the finish line that lies before us,” said Mike McGovern, Chair, International PolioPlus Committee, Rotary International.

Downloads

Investment Case 2022-2026

Media contacts:

Oliver Rosenbauer
Communications Officer, World Health Organization
Email: rosenbauero@who.int
Tel: +41 79 500 6536

Ben Winkel
Communications Director, Global Health Strategies
Email: bwinkel@globalhealthstrategies.com
Tel: +1 323 382 2290

Sabrina Sidhu
UNICEF New York
Email: ssidhu@unicef.org
Tel: +19174761537

April 2022 – Convening this month in Geneva, Switzerland, the Strategic Advisory Group of Experts on immunization (SAGE), the global advisory body to the World Health Organization (WHO) on all things immunization, urged concerted action to finish wild polioviruses once and for all.

The group, reviewing the global wild poliovirus epidemiology, highlighted the unique opportunity, given current record low levels of this strain. At the same time, it noted the continuing risks, highlighted in particular by detection of wild poliovirus in Malawi in February, linked to wild poliovirus originating in Pakistan.

On circulating vaccine-derived poliovirus (cVDPV) outbreaks, SAGE expressed concern at continuing transmission, in particular in Nigeria which now accounts for close to 90% of all global cVDPV type 2 cases, as well as the situation in Ukraine, and its disruption to health services, urging for strengthening of immunization and surveillance across Europe. It also noted the recent detection of cVDPV type 3 in Israel in children, and in environmental samples in occupied Palestinian territories, and urged high-quality vaccination activities and strengthened surveillance.

Preparing for the post-certification era, the group underscored the importance of global cessation of all live, attenuated oral polio vaccine (OPV) use from routine immunization, planned one year after global certification of wild poliovirus eradication. To ensure appropriate planning, coordination and implementation, the group endorsed the establishment of an ‘OPV Cessation Team’, to consist of wider-than-GPEI stakeholder participation and ensure leadership on all aspects of OPV cessation.

SAGE will continue to review available evidence and best practices on a broad range of GPEI-related programmatic interventions, including as relevant the increasing role of inactivated polio vaccine (IPV), including in outbreak response and effects of novel oral polio vaccine type 2 (nOPV2), as part of global efforts to secure a lasting world free of all forms of poliovirus.

After the safe and successful rollout of nationwide polio campaigns since November 2021, we have received tragic news that 8 health workers at the forefront have been killed this morning in a series of shootings in Takhar and Kunduz in northeast Afghanistan. The vaccination campaign has been suspended in both provinces.

A statement has been issued by the Regional Director of WHO’s Eastern Mediterranean Region, Dr Ahmed Al-Mandhari, as well as by the United Nations in the country, condemning these attacks, expressing condolences to the families and underscoring that the provision of health and the safety of healthworkers at the forefront are paramount, and must be kept neutral to any geo-political situation anywhere.

Our thoughts and prayers are both with the families and our teams on the ground at this time.

Cairo, 10 February 2022 – The fourth meeting of the Regional Subcommittee on Polio Eradication and Outbreaks was convened on Wednesday 9 February, by WHO’s Regional Director for the Eastern Mediterranean Dr Ahmed Al-Mandhari. The meeting was attended by health ministers or their representatives from Djibouti, Egypt, the Islamic Republic of Iran, Pakistan, Qatar, Saudi Arabia, Sudan, United Arab Emirates and Yemen.

The Subcommittee declared the ongoing circulation of any strain of poliovirus in the Region to be a regional public health emergency and called on all authorities to enable uninterrupted access to the youngest and most vulnerable children through the resumption of house-to-house vaccination campaigns. It issued statements on wild poliovirus circulation in Afghanistan and Pakistan and on the circulation of vaccine-derived poliovirus strains in Yemen, where limits on house-to-house vaccination are preventing access to the most vulnerable children.

The spread of polio in the Eastern Mediterranean Region is a pressing emergency and it remains a Public Health Emergency of International Concern (PHEIC) under the International Health Regulations (IHR 2005).

Members noted a sharp decrease in cases of wild poliovirus in Afghanistan and Pakistan in 2021 but warned against complacency.

“Wild poliovirus transmission is at a historic low in the endemic countries of Afghanistan and Pakistan. The progress is remarkable, but it is fragile. The opportunity to end polio is knocking at our door, and we must seize it,” said Dr Al-Mandhari.

Speaking to the progress made in the last year, the Special Assistant to the Prime Minister on Health, Dr Faisal Sultan, assured members that the programme in Pakistan was leaving no stone unturned in the pursuit of zero polio transmission.

“We have intensified efforts in the hardest districts and core reservoirs and we are closely monitoring transmission across the border in coordination with Afghanistan, taking measures to respond to outbreaks if they occur and making every effort to ensure that the virus doesn’t spill over in either direction. To boost the confidence of marginalized communities, we are also providing essential services and vaccination of other antigens and diseases,” he said.

Outbreaks of circulating vaccine-derived polioviruses type 1 (cVDPV1) and type 2 (cVDPV2) continued to emerge and spread in the Region in 2021. As of February 2022, Afghanistan, Djibouti, Egypt, Pakistan, Somalia, Sudan and Yemen are responding to transmission of vaccine-derived polioviruses.

“The increasing outbreaks of circulating vaccine-derived poliovirus type 2 in the Eastern Mediterranean Region and neighbouring countries of Africa are deeply concerning and must be stopped rapidly. To do so, we need to ensure that we are creating an enabling environment for health workers to reach children with those two drops of polio vaccine,” said newly nominated co-chair H.E. Dr Hanan Mohamed Al Kuwari, Minister of Public Health of Qatar.

During the meeting, Djibouti’s Public Health Minister, Dr Ahmed Robleh Abdilleh, shared plans for vaccination campaigns and increased surveillance in response to the transmission of cVDPV2, recently detected through the newly launched environmental sampling programme.

Reflecting on the work of the Subcommittee, co-chair and Minister of Health and Prevention of the United Arab Emirates H.E. Abdul Rahman Mohammed Al Owais urged members to sustain the commitment seen in in 2021.

“We have together advocated for an increase in domestic funds, we have driven collaborative public health action in our own countries, and collectively pushed for a regional response to address the regional public health emergency of the poliovirus. But these things alone will not end transmission,” he said.

Dr Al-Mandhari expressed appreciation for Egypt’s role as the first country in the Region to roll out a nationwide vaccination campaign using the novel poliovirus vaccine, and Chris Elias, Chair of the Polio Oversight Board, praised the remarkable progress made in polio eradication in Pakistan with support of the United Arab Emirate’s Pakistan Assistance Programme.

“This regional solidarity and commitment we have seen, through this Subcommittee, is something I am proud of. It is this commitment to the end goal that will help push us over the last mile,” said Dr Hamid Jafari, director of the regional polio programme and co-facilitator of the Regional Subcommittee.

Dr. Nida vaccinating a young boy. © Nida Ali

Dr Nida Ali joined the Polio Eradication Programme in her native Pakistan in 2017. A graduate of the medical faculty at Hamdard University in Karachi, she reflects on her time with the programme, the role of women and the eradication of polio in one of the last countries where it remains endemic.

I worked for the polio programme in Pakistan for four years and 10 months. It wasn’t easy – but then, what is? I look back at those long years and cry at the times when I laughed and laugh at the times when I cried. The programme gave me lot: exposure, experience, learning opportunities, knowledge, skills, and excellent colleagues from whom I learned a lot. But the ultimate gain was, of course, the children in my own country, including my son, who took polio drops in every polio immunization campaign.

I joined the programme in 2017, as Polio Emergency Response Officer in the provincial office in Punjab. I’m originally from Rawalpindi and before joining the programme, I worked on a government-led Reproductive Health programme which sparked my interest in public health.

I’d read about polio as part of my paediatrics study at medical school but I didn’t see a case of polio until I joined the programme. It was WPV (Wild Poliovirus Type 1) and it was in Punjab, a very small child who wasn’t even a year old. The second case I saw was a case I investigated when I was working as a Polio Eradication Officer in Islamabad. All the signs were there – the child lived in a very densely populated household where the hygiene conditions weren’t good, in a part of town where a lot of travellers were coming and going. He’d also been what we call a ‘refusal’, meaning that his caregivers had refused to allow him to be vaccinated. I examined the child and it was a classic case of Acute Flaccid Paralysis, or AFP, one of the signs that the virus may be circulating in the community. The ankle reflex was present but the knee reflex was lost. We sent samples to the laboratory and it was declared as a positive case of polio.

I held a number of roles during my time with the programme – Area Coordinator, Rapid Response Officer, Divisional Surveillance Officer – and I was fortunate enough to travel to other provinces. I went to northern KP (Khyber Pakhtunkhwa) to respond to a WPV outbreak, and to southern KP and Gilgit-Baltistan for post campaign monitoring. I learned some phrases of the local language in northern KP – how many children do you have in the house, the numbers from one to ten, how many children are vaccinated, can I see their finger mark – phrases that helped me make a connection with mothers and understand their responses. I also used to take out my phone and show them photos of my son – he was four years old at the time – and tell them that he takes the polio drops in every campaign. It was great to make such a human connection and I was able to convince many refusals that way.

Seeing the programme at field level gave me great insights but so did working at the National Emergency Operations Centre (EOC) in Islamabad. It’s where all the work and knowledge comes together, and where staff from all the different the provinces come so it was a great opportunity to meet them and exchange experiences.

Women make up around 40 percent of the polio programme but mainly as frontline workers who go from house to house to vaccinate millions of children across the country. There aren’t so many women at higher levels, often because women don’t apply for these positions, which is a shame. On many occasions I found myself to be the only woman in a large meeting room, particularly the meetings where policies and protocols are discussed. I think the presence of more women in leadership roles will bring an interesting perspective to the programme, particularly given our roles as mothers and caregivers.

Today I’m in Atlanta, studying Global Health at Emory University. It was my experience with the polio programme that helped me get through all the stages of obtaining scholarship and a placement in such a reputed University. This is an interesting opportunity of learning from the experts, which again, is not new to me as this is exactly what I’ve been doing at the polio programme in Pakistan. I’m not sure where this will lead me – back to polio or to another part of public health, I don’t yet know. All I know is that I will go where my expertise leads me.

I hope one day I can tell my son the story of how polio was eradicated and how no child will ever be paralyzed by this virus again. I hope by that time, we direct our resources for protecting children from other diseases or, even better, to curb the infections that have potential to lock the whole world down.

The Executive Board Room at WHO Headquarters during the 150th EB session. © WHO

January 2022, Geneva, Switzerland – As the world enters 2022, and with it the year when the new GPEI Strategy 2022-2026 – Delivering on a Promise – takes effect, global public health leaders at this week’s WHO Executive Board urged for intensified eradication efforts to capitalize on a unique epidemiological window of opportunity. 2021 saw the lowest ever levels of wild poliovirus cases in history, with five cases reported from the remaining two endemic countries, Pakistan and Afghanistan. Cases of circulating vaccine-derived poliovirus have also declined compared to 2020.

Delegates attributed this favourable situation to sustained commitment from the highest levels in polio-affected areas, but issued severe warnings against complacency. “2021 set the stage for success,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus. “We must now not lower our guard.”

“What is clear is that in 2022, we have a very real and realistically achievable opportunity to finish wild poliovirus from the world once and for all,” said Aidan O’Leary, Director of the Global Polio Eradication Initiative, WHO. “But what is equally clear from the discussions at the Executive Board is that there is virtually no room for error now. If we take our foot off the accelerator even by a little bit, this virus will come roaring back, and we will perhaps have lost the best chance yet for success. The resounding message from this week’s meeting is this: we cannot allow this to happen. Success is the only acceptable outcome.”

Time and again, delegates, experts and partners such as Rotary International underscored the need to fully implement and finance the GPEI Strategy 2022-2026, highlighting that it clearly laid out the roadmap to achieving a lasting world free of all forms of polioviruses, through stronger community engagement, a renewed focus on gender equity and the rollout of new tools and technologies, including the novel oral polio vaccine type 2.

Delegates expressed appreciation at the polio programme’s ability to adapt to programmatic, epidemilogical and political developments, as demonstrated in Afghanistan last year, where – for the first time in more than three years – nationwide immunization campaigns resumed. At the same time, 2021 again saw the broader benefits of polio eradication, with health workers at the forefront supporting global COVID-19 response, vaccination and immunization recovery efforts, and the polio infrastructure now increasingly being integrated into broader public health systems in polio-free countries across the world.

With over 50 countries transitioning out of GPEI support in 2022, Member States also supported efforts to sustain the gains in polio-free countries, calling on WHO to continue its technical support in polio-free countries, and to ensure that polio assets, tools and expertise are effectively integrated into broader immunization, disease surveillance, primary health care, and outbreak preparedness and response efforts.

“Together with our partners at Rotary International, CDC, UNICEF the Bill & Melinda Gates Foundation and Gavi, the Vaccine Alliance, we will continue to support Member States in their eradication efforts,” concluded O’Leary. “But much is on the line. We have everything in place – we need to focus now fully on optimizing our tools and tactics, and ensuring the resources to do so are available. If those two things come together, we will be able to give the world one less infectious disease to worry about once and for all.”

Polio worker Soni Farhan has been selected for a Presidential Pride of Performance award, which honours individuals who are extraordinary in their field of work. © Syed Mehdi Bukhari/WHO — Polio worker Soni Faisal has been selected for a Presidential Pride of Performance award, which honours individuals who are extraordinary in their field of work. © Syed Mehdi Bukhari/WHO

Contracting the infectious virus at 11 months of age, few believed Soni would ever be able to work. Today, she’s a nominee for one of Pakistan’s most prestigious awards.

Soni started out in the programme in 1999, initially as a vaccinator. Now a mother of three children, these days, Soni works with the programme as a social mobilizer. Her role includes dispelling people’s misconceptions about the vaccine and engaging with parents about the importance of vaccinating their children.

When Soni received a notification from the Government of Pakistan that she had been selected for a Presidential Pride of Performance award, which honours individuals who are extraordinary in their field of work, she didn’t quite know how she felt. “I’m not really interested in accolades, but my son and my husband were very excited” she said.

Soni says her work with the polio eradication programme has given her life meaning and purpose. “People would look at my leg and say, ‘How will she work?! She can’t work. But when I started working, then everyone could see, ‘yes, yes she can’,” she says.

“The polio programme has given me so much confidence. After I started working in polio, I had the confidence of meeting new people. Meeting family, going to weddings, all of it became easier. Before that, I had no confidence to even step out of the house,” she continues.

Soni recalls how hesitant her father was when she first told him she wanted to join the programme. “He was concerned I won’t be able to manage because of my health, but he understood very soon that this was something I just had to do. He told my mother ‘let her do it’.”

During her early training as a vaccinator, Soni recalls the words of one of her trainers – ‘If you can save one child from polio, then you would have served the purpose of your life’. “I knew, then, this was it, “she says. “This is what I had to do.”

The year Soni was diagnosed with polio – 1984 – nearly 200 other children in her neighbourhood of Liaquatabad in Karachi were also diagnosed with the virus. At the time, there were no door-to-door campaigns and children could only be vaccinated at health centres.

Today, Pakistan and Afghanistan are the last two countries in the world where wild poliovirus is endemic. In 2021, only one child was paralyzed by the virus in Pakistan and four in neighbouring Afghanistan. In 2020, a total of 84 cases were reported in Pakistan and 56 in Afghanistan.

The eldest of six siblings, Soni came from a very conservative family, where her grandmother would not let children leave the house. “In our family, all the children were born at home because the women were not allowed to leave the house, and so I was never taken to a health centre for vaccination.”

“My father always lived with the regret of not vaccinating his daughter,” she says. “Often parents make these decisions, and it is the child who has to suffer for all their life.”

Both Soni’s parents tried everything they could to heal her condition – visiting different doctors, acupuncture specialists, and anyone they could find who might offer any assurances. She also went through a very extensive operation, with steel bolts put in her leg resulting in excruciating pain that lasted for months.

“No matter what you do, whatever you try, there is no cure for polio,” she says. “I wanted to study sciences, and my teacher didn’t allow me to because she would say how will you stand in labs all day. I would go to college and one of the women in the bus would see me and say ‘Look at her, such a beautiful girl and look at what happened to her foot’.”

Soni says that when she is working on campaigns and some people see her, they immediately want to vaccinate their children, while others question why she is telling them to vaccinate while having polio herself.

“To them I say, I am here because I know exactly how hard it is if you are not vaccinated.”

In November:

No case of WPV1 was confirmed
35 million children were vaccinated during the MR Campaign in November 2021.
1 million children were vaccinated at 73 Permanent Transit Points

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Vaccination team crossing river in West Garo Hills of Meghalaya. ©WHO

With the ongoing COVID-19 pandemic, continued wild polio transmission in the remaining endemic countries and spreading outbreaks of circulating vaccine-derived polioviruses type 2 (cVDPV2), this year began with many challenges facing polio eradication efforts. But amid this new reality, countries and partners of the Global Polio Eradication Initiative (GPEI) intensified their efforts to protect children from lifelong paralysis.

In June, the GPEI launched the new GPEI Strategy 2022-2026, which lays out the roadmap to achieving a lasting world free of all forms of polioviruses through stronger community engagement, a renewed focus on gender equity and the rollout of new tools and technologies. These new tools include the novel oral polio vaccine type 2 (nOPV2), which began deployment under Emergency Use Listing (EUL) as part of the GPEI’s broader polio vaccine repository to curb cVDPV2 transmission. In August, the WHO African Region celebrated one year since it was certified wild polio-free, and countries recommitted to strong cVDPV2 outbreak response across the continent with the support of the GPEI.

Further critical progress took place in Afghanistan – one of two final countries endemic for wild poliovirus, along with Pakistan. For the first time in more than three years, nationwide polio immunization campaigns resumed across Afghanistan reaching 8.5 million children, including 2.4 million children who were previously inaccessible.

At the same time, polio programme health workers at the forefront continued to support global COVID-19 response efforts by delivering vaccines, mobilizing communities, and countering misinformation among other activities. The use of GPEI infrastructure for health emergency response has provided critical lessons for integrating polio resources into broader health systems as more countries work towards transition and the post-certification period.

Containment area monitoring in India. ©WHO

Following dire predictions issued at the end of 2020, the polio programme once again proved its ability to adapt to programmatic, epidemiological and political developments. Entering 2022, there is much cause for cautious optimism – wild poliovirus transmission has slowed drastically, and cases of cVDPV2 have also declined compared to last year.

Importantly, commitment to achieving a lasting polio-free world is evident at all levels: by core GPEI partners, including among the Polio Oversight Board, which travelled to Pakistan twice in 2021; by health workers, communities and parents; and by country leaders worldwide who helped champion this year’s milestones. With the new strategy, new tools and adapted approaches, the stage is set to achieve lasting success.

To stop all forms of polio for good, the GPEI aims to capitalize on the positive epidemiological situation leading into 2022. A key opportunity to kick-start the year will be the WHO Executive Board meeting in January, where Member States plan to discuss building on the successes of this past year by fully implementing and financing the programme’s new strategy. Rotary and other key global GPEI partners are planning a renewed and intensified outreach across the broader international development community to secure the necessary financial resources to achieve success. Polio immunization campaigns will also continue in full force in both endemic and outbreak countries.

Twelve months ago, the programme was in a much different place, as WHO and UNICEF launched an Emergency Call to Action to draw attention to the need for renewed commitment. A year later, thanks to a strengthened and unified response, the GPEI is meeting the moment and is more committed than ever to end all forms of poliovirus, once and for all.

WHO Regional Director, Dr Ahmed Al-Mandhari, observes polio vaccination in Karachi. ©WHO EMRO

In November, George Laryea-Adjei (Regional Director for South Asia, UNICEF) and Dr Ahmed Al-Mandhari ( WHO Regional Director for the Eastern Mediterranean ) joined fellow GPEI leaders on a visit to Pakistan. The regional directors met with government stakeholders and health workers, and commended Pakistan on its impressive progress interrupting poliovirus transmission. See why the regional directors emphasized that there is no room for complacency on the path to a polio-free Pakistan. For more information please visit WHO Regional Office for the Eastern Mediterranean and UNICEF websites.

In October:

No case of WPV1 was confirmed
3.53 million children were vaccinated during October 2021 in KP outbreak response.
0.6 million children were vaccinated at 73 Permanent Transit Points

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In September:

No new Wild Poliovirus (WPV1) case and no new cVDPV2 cases were confirmed.
809 981 children were vaccinated against polio

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In September:

No case of WPV1 was confirmed
41.5 million children were vaccinated during NIDs.
0.8 million children were vaccinated at 72 Permanent Transit Points

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In August:

No case of WPV1 was confirmed
23.4 million children were vaccinated during sNIDs.
1 million children were vaccinated at 121 Permanent Transit Points

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The Health Ministers of the G20 countries, meeting in Rome, Italy, on 5-6 September 2021, recommitted to helping secure a lasting polio-free world once and for all. In their official communiqué, the Health Ministers said: “We re-affirm our commitment to eradicate polio… We note the critical role that adaptable surveillance capacity, like that found in the Global Polio Eradication Initiative, has in the ability to reach vulnerable communities to prevent and respond to pandemics.”

The importance to eradicate polio, and the GPEI’s unique value in supporting COVID-19 response efforts, had previously been underscored by other global fora, including at the recent WHO Regional Committee for Africa, the G7 Heads of State meeting, the G7 health ministers meeting and the World Health Assembly.

An integral part of the new GPEI Strategy 2022-2026 is to ensure close coordination with broader public health efforts, to not only achieve a lasting world free of all polioviruses, but also one where the polio infrastructure will continue to benefit other public health emergencies long after the disease has been eradicated. Key to success, however, will be the continued support and engagement of the international development community, including by ensuring that previous pledges are fully and rapidly operationalized.

The GPEI also recognizes the critical role of women in the delivery of health services and has committed to ensuring their empowered engagement in polio eradication efforts in order to reach every last child.

25 August 2021 – “Poliovirus circulation does not stop during conflicts, it does not stop during emergencies. If anything, it makes children and families even more vulnerable by adding a layer of risk”, says a Polio Provincial Officer from Balkh province.

Despite risks and challenges due to the recent insecurity, the polio programme is staying and delivering for the children of Afghanistan. Our 315 staff and more than 70,000 polio health workers across the country remain firm in their resolve to eradicate polio. Their work ensures that critical polio activities continue while adapting to the rapidly changing situation and carry on even when hostility levels are high.

In 2021, one wild poliovirus type 1 (WPV1) and 43 circulating vaccine-derived poliovirus type 2 (cVDPV2) cases have been confirmed in Afghanistan. All cases have been reported in areas of the country that have for years been inaccessible for door-to-door vaccination campaigns, which left at least 3 million children repeatedly deprived of polio vaccination. Population displacement brought about by the current situation could further impact the programme’s access to children and increase immunity gaps against polio, triggering a rise in transmission. It is also feared that the mixing and movement of unvaccinated populations due to the upheaval faced by thousands of Afghans may spur polio transmission.

“We are working with all actors, to ensure there are no delays or disruptions to polio vaccination campaigns and overall routine immunization. Gains of the past twenty years cannot be lost. Children need immunization now, they must not bear the brunt of conflict and instability. We are calling for unimpeded access to all children,” says Dr. Dapeng Luo, WHO Representative in Afghanistan.

Pre-planning and resilience measures

While the current situation is a challenge, it is by no means the first the polio programme has faced. Using its wealth of knowledge from many years of operating in complex environments, the programme has invested in robust, pre-emptive contingency planning to be able to adapt and continue delivering. Regular monitoring of the security situation has allowed for nimble decision making.

The programme has moved swiftly to ensure safety and security of its staff. Its international staff footprint has been significantly reduced and vulnerable national staff and their dependants have been temporarily relocated to Kabul. Flexible working arrangements and salary advances have been provided to cover urgent needs of staff and polio health workers, who are the backbone of polio operations.

Around eighty percent of polio staff remain at their field locations and working to maintain essential polio services, supported remotely by colleagues who have needed to relocate.

“I am filled with pride for my team and their strong resolve, courage and passion. They are the heroes children of Afghanistan need right now. Thanks to their efforts, Acute Flaccid Paralysis (AFP) and environmental surveillance never stopped. Except for a few locations that experienced temporary disruptions last week, stool sample collection, visits to active health facilities, case investigation, the shipment of samples to Pakistan for laboratory testing, and the collection and transport of sewage samples for polio environmental surveillance remain unaffected. COVID-19 surveillance, which the polio programme has been supporting since last year, has also continued,” says Irfan Elahi Akbar, Polio Team Leader, WHO Afghanistan.

Vaccination continues

Polio vaccinations are continuing through permanent transit teams in most regions and at cross-border sites, including Friendship Gate (between Afghanistan and Pakistan).

After a brief pause, the National Emergency Operation Center is back up-and-running and undertaking planning needed to implement future campaigns. Discussions are ongoing with local authorities to safeguard the resumption of critical immunization activities across the country. The programme remains optimistic that polio vaccination campaigns planned for later this year can go ahead, however, is maintaining a flexible approach.

“The safety and security of staff and polio health workers is our top priority. Their commitment to ending polio is nothing short of inspirational. I stand ready to support their critical work in any way I can. I say this with absolute conviction: We will achieve a polio-free world,” said Dr. Hamid Jafari, Director of Polio Eradication, WHO Eastern Mediterranean Region.

See link to story on WHO EMRO’s website.

The Global Polio Eradication Initiative (GPEI) is closely monitoring developments in Afghanistan. GPEI partners and staff are currently assessing immediate disruptions to polio eradication efforts and the delivery of other essential health services, to ensure continuity of surveillance and immunization activities while prioritizing the safety and security of staff and frontline health workers in the country.

The polio programme in Afghanistan has operated for many years amid insecurity and conflict, and will continue working with all actors, agencies and organizations who enable delivery of immunization as well as deliver humanitarian assistance to populations in need across the country. The GPEI remains steadfastly committed to protecting all children from polio and supporting the provision of other essential immunizations and health services.

We strongly believe that the delivery of health care – including polio vaccination – is essential to prevent diseases and safeguard communities. Together with our partners, the people of Afghanistan, national and provincial authorities, we will do everything in our power to continue this critical work.

In July:

No case of WPV1 was confirmed
1,2 million children were vaccinated at 121 Permanent Transit Points