GPEI-Q&A with Helen Rees

A young girl from Kano state, Nigeria, receiving the life-saving polio drops. © WHO

The WHO African Region is expected to be certified free of wild poliovirus on 25 August 2020. Chair of the WHO’s International Health Regulations Emergency Committee and of the AFRO Regional Immunization Technical Advisory Group Helen Rees explains the current cVDPV situation in Africa and its implications ahead of regional wild polio-free certification.

Q. Fifteen countries (as of 14 August 2020) in the World Health Organization’s African region have reported cases of circulating vaccine-derived polio type 2 (cVDPV2) in 2020. The total number of outbreak countries is 16. How does that impact the region’s upcoming wild polio-free certification?

First, it’s important to clarify that cVDPV is a different virus from the wild poliovirus, and will undergo a separate process to validate its absence once wild polio has been eradicated globally.

Second, I want to underscore that the ongoing cVDPV2 outbreaks in Africa do not affect the programme’s confidence that wild polio is gone from the region. Certification is backed by extensive data and a thorough evaluation process that demonstrates wild polio transmission has been interrupted on the continent.

In Africa, an independent body of experts called the African Regional Certification Commission for polio eradication (ARCC) oversees this process by carefully reviewing country documentation and analyzing the quality of surveillance systems and immunization coverage. With this intensive monitoring of polio programmes across the continent, the ARCC is able to confirm with 100% certainty that wild polio is gone from the region.

But for the ARCC, national polio programmes and GPEI partners, the work does not end here. Stopping cVDPVs remains an urgent priority. African countries will need to strengthen their efforts to reach all children with polio vaccines to protect them from cVDPVs and any importation of wild polio from the remaining endemic countries, Pakistan and Afghanistan.

How do cVDPV outbreaks happen? And why has the number of cVDPV cases in Africa increased more rapidly in the past couple years while wild cases have not?

cVDPVs can occur if not enough children receive the polio vaccine. In under-immunized populations, the live weakened virus in the oral polio vaccine (OPV) can pass between individuals and, over time, change to a form that can cause paralysis—resulting in cVDPV cases. This means that the cVDPV outbreaks we’re seeing today are revealing pockets across the continent where immunization rates are too low.

The reason for the increase in cases can be explained by low immunity to type 2 poliovirus, which causes the vast majority of cVDPV cases. This is in part due to a global vaccine switch that occurred in 2016, when countries stopped using the trivalent OPV (which protects against all three forms of polio) and replaced it with the bivalent OPV (which protects against just type 1 and 3).

The GPEI, following the advice of the Strategic Advisory Group of Experts, decided to make this vaccine switch based on extensive evidence that showed it would decrease the number of cVDPV outbreaks. However, immunity to type 2 poliovirus was lower than predicated at the time of the switch and so there were actually more cVDPV2 outbreaks. In response to the cVDPV2 outbreaks monovalent oral polio vaccine type 2 (mOPV2) has been used to interrupt transmission. But with increasing numbers of children who do not have type 2 immunity, mOPV2 vaccines have had to be used longer and in larger quantities than was initially anticipated. This larger and more extensive use of mOPV2 vaccines has seeded new outbreaks especially in areas of low immunization coverage and on the borders of outbreak response zones.

All this said, mOPV2 is an effective tool to stop cVDPV outbreaks if children are properly immunized.

If cVDPV outbreaks can only affect under-immunized communities, doesn’t the increasing number of outbreaks indicate that polio immunity levels are too low across the region? Why were countries able to stop wild polio then?

For years, the wild poliovirus has only existed in a small area on the continent. Nigeria reported its last case of paralysis due to wild polio four years ago, but most other countries haven’t seen a wild polio case in quite some time.

Across the continent, population immunity levels to type 1 polio (the only type of wild polio that remains in the world) and surveillance networks have continued to protect against any wild polio importation from remaining wild polio endemic countries.

However, the increasing number of cVDPV outbreaks across Africa is a reminder that countries cannot afford to let their guard down, and must continue reaching every child with the polio vaccine.

A young child receiving polio vaccination. ©WHO/Nigeria

What is the programme doing to address cVDPVs in Africa?

The same tactics that stop wild polio can be used to stop cVDPVs – high vaccination coverage and strong surveillance. The polio programme in Africa has proven experience and strategies to address cVDPV outbreaks. But we know that we cannot rely only on existing tactics, which is why the programme is innovating and adapting its strategies to address the challenge of cVDPVs specifically.

In early 2020, the GPEI released a comprehensive new strategy to stop cVDPV outbreaks currently affecting countries in Africa, Asia and the Middle East.

This includes revising outbreak response standard operating procedures to improve response time, doubling the size of the African Rapid Response Team, forming a global Rapid Response Team and prioritizing the GPEI’s ground presence in high-risk areas.

To raise immunization coverage, the GPEI partners – including Gavi, the Vaccine Alliance – are working to build and strengthen immunization systems in at-risk countries and expand routine immunization with the inactivated polio vaccine (IPV).

The strategy also includes the development of an additional tool to help stop cVDPV2 outbreaks – novel oral polio vaccine type 2 (nOPV2). nOPV2 is a modified version of the existing mOPV2 used to respond to cVDPV2 outbreaks that is less likely to change to a form that can cause paralysis.

The GPEI is confident that with strengthened commitment from country governments and full implementation of the tactics laid out in its strategy, cVDPVs can be wiped out across Africa.

Has COVID-19 affected the programme’s ability to stop cVDPV outbreaks in the region?

The recent pause in house-to-house polio campaigns to help control the spread of COVID-19 is expected to increase cVDPV transmission across affected countries.

The GPEI is taking a number of steps to get back on track. Even while campaigns were paused, surveillance activities continued so that as immunization activities ramp up the programme can target campaigns in areas that are most at risk.

The GPEI recently recommended that all countries with active polio transmission resume vaccination activities as soon as it is safe to do so, in line with WHO and national COVID-19 guidance. Burkina Faso and Angola were among the first countries to start implementing cVDPV outbreak response campaigns after the pause.

These campaigns are closely following safety guidelines and social distancing measures to protect communities and health workers against COVID-19. Measures including the use of masks and gloves, frequent handwashing and no-touch vaccination.

COVID-19 undoubtedly represents a setback for polio eradication, but not the first one the programme has faced. The GPEI and African countries’ national polio programmes are committed to ensuring that countries are ready to tackle the remaining challenge of cVDPVs and to recover lost ground once polio activities can safely ramp up.

Nurse Madelein Semo vaccinates a young baby with inactivated polio vaccine (IPV) at the Ngbaka health centre in Kinshasa, Democratic Republic of the Congo, on April 29, 2015. Gavi’s support for IPV represents the insurance policy for the success of the Polio Endgame Strategy. ©GAVI/2015/Phil Moore

On 4 June 2020, the UK Government hosted Gavi’s third donor pledging conference, the Global Vaccine Summit, to mobilize at least US$ 7.4 billion to protect the next generation with vaccines, reduce disease inequality and create a healthier, safer and more prosperous world. Responding to this unique call for global solidarity, leaders from donor countries and the private sector made unprecedented commitments of US$ 8.8 billion in order to save up to 8 million lives.

Since 2019, the Global Polio Eradication Initiative (GPEI) has strengthened its collaboration with Gavi, inviting Gavi to become the sixth core partner of the GPEI. While the GPEI will continue its focus on interrupting virus transmission and eradicating polio through immunization campaigns using the oral polio vaccine (OPV), Gavi’s support for the inactivated polio vaccine (IPV) at an estimated cost of US$ 800 million during its 2021-25 strategic period represents the insurance policy for the success of the Polio Endgame Strategy.

Thanks to the remarkable mobilization and solidarity of leaders worldwide, Gavi will be able to maintain immunization in developing countries, mitigating the impact of the COVID-19 pandemic. Gavi will also be able to sustain health systems so that countries are ready to rapidly introduce COVID-19 vaccines. And by 2025 Gavi will have immunized more than 1.1 billion children, saving 22 million lives. Ngozi Okonjo-Iweala, Chair of the Gavi Board, highlighted why this is so important, saying, “Vaccinations should be recognized as a global public good. With your support and commitment, we can generate US$ 70 to US$ 80 billion additional economic benefits.”

Henrietta Fore, Executive Director of UNICEF, added, “We have effective vaccines against measles, polio and cholera. While circumstances may require us to temporarily pause some immunization efforts, these immunizations must restart as soon as possible, or we risk exchanging one deadly outbreak for another.” UN Secretary-General Antonio Guterres urged partners to “find safe ways to continue to deliver vaccinations during COVID-19.” GPEI, Gavi, WHO and UNICEF have issued guidance for countries to encourage resuming immunization activities once it is safe to do so, in recognition of the fact that numerous countries are facing COVID-19 and multiple other disease outbreaks.

During the Summit, top Gavi donors reaffirmed their leadership, including Norway, the UK and the USA, as well as the Bill & Melinda Gates Foundation. Prime Minister Boris Johnson pledged £1.65 billion, recommitting the UK as Gavi’s leading donor while the Gates Foundation committed US$ 1.6 billion. More than 60 leaders from all regions of the world in the Asia-Pacific, Middle East, Africa, Europe and the Americas pledged support to Gavi, the Vaccine Alliance both for its upcoming strategic period as well as for COVID-19 response.

The COVID-19 pandemic reminds us of the power of vaccines. WHO Director-General Tedros Adhanom noted, “COVID-19 is a devastating reminder that life is fragile, and that in our global village our individual health depends on our collective health. … Now is the moment for the world to come together in solidarity to realise the power of vaccines for everyone.” Responding to this challenge, Gavi has launched the Gavi Advance Market Commitment for COVID-19 (Gavi Covax AMC), which aims to raise additional funding in late June under the leadership of the European Union. Bill Gates, noted, “We would have to create Gavi if it did not exist today to solve the COVID-19 crisis.”

Michel Zaffran, director of the WHO polio eradication programme, said, “Congratulations to the Gavi family for this exemplary mobilization and demonstration of global solidarity. We are immensely grateful to Gavi and its donors for their precious partnership and generous support for the inactivated polio vaccine (IPV). The COVID-19 pandemic is a terrible tragedy, which brings us together more than ever and requires to think collectively how best to address the needs of the communities.”

Rotary, one of the six GPEI partners, echoed statements from other agencies. “Rotary and its members applaud the commitment of the donors and governments who have pledged their support to ensuring that vulnerable communities can receive lifesaving vaccinations,” said Michael K. McGovern, Polio Oversight Board and Chair of Rotary’s International PolioPlus Committee. “Continued investment from the global community in programmes such as the Global Polio Eradication Initiative is crucial to not only achieving the eradication of polio, but ensuring stronger health systems worldwide. This firm commitment truly embodies the “Plus” in PolioPlus.”

While the Global Vaccine Summit secured the IPV requirements for polio eradication efforts through 2025, further financial commitment is needed for the GPEI to restart the immunizations campaigns that have been paused during the COVID-19 pandemic. More intensive and integrated immunization activities are needed to finish the job and to strengthen the capacities of the governments, health workers and networks, so that the investment in polio eradication can serve as a foundation for future pandemic response. While celebrating the success of the Global Vaccine Summit, GPEI calls for reiterated donor support to eradicate polio once and for all.

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Tahira and daughter Dua attend a routine immunization session in Punjab province, Pakistan in January 2018. It is critical that immunization delivery systems are sustained through the COVID-19 pandemic. ©WHO Pakistan/Asad Zaidi

This month, world leaders have joined together to make several important commitments to strengthening public health infrastructure during the COVID-19 response – investments that will go a long way in protecting the most vulnerable communities, including those affected by polio.

On 4 May 2020, heads of government, institutions and industry pledged USD $7.4 billion (of the USD $8 billion goal) to ensure equitable access to new tools for COVID-19 globally. The funding will support the Access to COVID-19 Tools Accelerator, which will help develop new global health technology solutions to test, treat and protect people, and prevent the disease from spreading.

A day later, several donors pledged new funding to Gavi, one of the partners of the Global Polio Eradication Initiative (GPEI), ahead of its upcoming replenishment in June 2020. This funding will not only help vaccinate hundreds of millions of children against diseases such as polio, but also ensure that immunization delivery systems are sustained through the pandemic.

The GPEI greatly appreciates outstanding donor community support for both the COVID-19 response effort and routine immunization programmes around the world.

The GPEI is continuing to do its part to support the COVID-19 pandemic, in solidarity with other health initiatives. In March, the Polio Oversight Board made the recommendation to pause polio vaccination campaigns to limit further spread of the disease. Countries extended their key polio eradication assets, like infrastructure and human resources, to support countries’ COVID-19 response efforts, while continuing essential activities. As of May, GPEI resources, including surveillance laboratories, and social mobilization and communication networks, are supporting COVID-19 response in at least 55 countries.

The pause of vaccination campaigns and the disruption of routine immunization services leaves millions of children at high risk of contracting polio, measles and other vaccine preventable diseases (VPDs). The COVID-19 pandemic has demonstrated that vaccines, against both COVID-19 and VPDs, are crucial to protecting individuals, communities and economies.

As countries continue to implement their COVID-19 response plans, WHO and UNICEF are working with emergency and immunization partners to ensure the polio infrastructure not only supports the response, but also is fully funded in alignment with the ongoing efforts to finance COVID-19. While work is ongoing to cost those requirements, the GPEI hopes that specific COVID funds will be able to contribute towards its response efforts.

It is critical that essential health services and systems, including polio eradication efforts, have necessary support during both the response and recovery phases of this pandemic. While the GPEI has extended its assets to the global COVID-19 response effort, sustaining these programmatic resources is imperative. Continued donor commitments will enable the safe and effective resumption of polio vaccination campaigns as the situation evolves.

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A polio worker administering the life-saving polio drops to children in Pakistan © WHO/EMRO

In the midst of the COVID-19 pandemic, it is more critical than ever to recognize the power and importance of vaccines, which save millions of lives each year. Canada, the first government to contribute to the global effort to eradicate polio in 1986, has announced new investments to support immunization. Alongside renewed funding for Gavi, the Vaccine Alliance, the Honourable Karina Gould, Canada’s Minister of International Development, committed C$ 47.5 million annually over four years to support the Global Polio Eradication Initiative’s Endgame Strategy.

Due to widespread polio vaccination efforts over the past 30 years, more than 18 million people are walking today who would otherwise have been paralyzed, and cases have dropped by 99.9% thanks to the tireless efforts of health workers, local governments and global partners. The GPEI is proud to count on generous donors, including Canada, who have helped make this progress possible. This new investment will help the programme ensure gains made to date are not lost, resume activities as soon as it is feasible, implement strategies to overcome the remaining barriers to eradication, and further the dream of a polio-free world.

Minister Gould stated: “As a global community, we must work to ensure that those most vulnerable, including women and children, have access to vaccinations to keep them healthy wherever they live. COVID-19 has demonstrated that viruses do not know borders. Our health here in Canada depends on the health of everyone, everywhere. Together, we must build a more resilient planet.” The Minister added “The world has never been closer to eradicating polio, but the job is not done. With continued transmission in Afghanistan and Pakistan, we cannot afford to be complacent.”

Frontline polio workers in countries around the world are currently supporting the COVID-19 response, using networks established by the GPEI to focus on case detection, tracing, testing and data management. The G7 and the G20, including the Canadian Government, have recognized the important role GPEI assets play in strengthening health systems and advancing global health security, especially among the most vulnerable populations of the world.

In line with its feminist international assistance policy, Canada has encouraged the GPEI to build on the important role played by women in the programme, from the front lines to programme management and political leadership.

Akhil Iyer, Director of the Polio Eradication Programme at UNICEF said, “The new funding from the Canadian government is a testament to the major role played by the Canadian people in the historical fight against polio, and I am proud to be part of this endeavour as a Canadian citizen myself. Back in the 1950’s in Canada, poliovirus outbreaks could have paralysed or killed so many more children, and could have plagued the economy and pushed millions in vicious circles of poverty and ill health. But thanks to the scientific breakthrough of Dr. Leone Farrell who made mass production of polio vaccines possible, strong leadership and a learning health system, Canada was able to overcome the polio outbreaks and thrive during the following decades. It is more inspiring than ever, as we strive together to end polio from the world for good.”

Rotary clubs throughout Canada welcomed the new pledge as a continuation of the country’s leadership and partnership to end polio. Canada has worked closely with Rotary clubs in Canada since 1986 when Canada became a donor to GPEI. To date, Canadian Rotarians have raised and contributed more than US$ 41.3 million to eradication efforts.

Michel Zaffran, Director of the Polio Eradication Programme at the World Health Organization said, “I would like to express the profound gratitude of the GPEI partners to the Government and to the citizens of Canada for their tremendous support and engagement to end polio globally. The pandemic we are facing today is a stark reminder of the critical need for solidarity at all levels, international cooperation and of the power of vaccines and immunization. Canada is walking the talk: it is demonstrating once more its exemplary commitment to ensuring access to essential vaccinations, leading efforts to advance gender equality and reducing the burden of infectious diseases.”

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

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

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

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

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

Reposted with permission from Rotary.org.

Isiaku Musa Maaji, a polio survivor himself, makes a living by building tricycles for people with mobility impairments. © Rotary International

When we talk about PolioPlus, we know we are eradicating polio, but do we realize how many added benefits the programme brings? The ‘plus’ is something else that is provided as a part of the polio eradication campaign. It might be a hand-operated tricycle or access to water. It might be additional medical treatment, bed nets, or soap.

This series looks at the ‘pluses’ that Rotarians worldwide help to provide. Our first article looked at prevention of other diseases, and in part two we investigated how Rotary contributes to clean water provision. In our final article, we consider how Rotarians support those who have contracted polio, and who now live with permanent paralysis.

Creating jobs

Polio paralysis left Isiaku Musa Maaji, who lives in Nigeria, with few ways to make a living. At 24, he learned to build hand-operated tricycles designed to provide mobility for adults and children with physical disabilities, and later started his own business assembling them. His first break came, he says, when his local government placed a trial order. Officials were impressed with his product, and the orders continued.

Rotary’s Nigeria PolioPlus Committee recently ordered 150 tricycles from Maaji to distribute to polio survivors and others with mobility problems. The relationship he has built with local Rotarians has motivated him to take part in door-to-door polio vaccination campaigns.

“It is not easy to be physically challenged,” he says. “I go out to educate other people on the importance of polio vaccine because I don’t want any other person to fall victim to polio.”

Aliyu Issah is now a strong advocate for polio immunization. © Rotary International

Aliyu Issah, another polio survivor, feels lucky; he’s able to support himself running a small convenience store. He knows others with polio paralysis who have attended skills training programmes but lacked the money to start a similar business. In the absence of ready employment, some of them were forced to beg on the street.

He notes however that the polio eradication programme provides a job that is uniquely suited to polio survivors: educating others about the effects of the disease.

“Some of my friends who used to be street beggars now run their own small business with money they earn from working on the door-to-door immunization campaign,” Issah says.

Improving health care

In Maiduguri, Nigeria, Falmata Mustapha rides a hand-operated tricycle donated to her by Rotary’s Nigeria PolioPlus Committee. She is joined by several health workers for a door-to-door immunization campaign, bringing polio drops to areas without basic health care.

Falmata Mustapha uses her hand-operated tricycle for door-to-door campaigns. ©Rotary International

UNICEF data show that polio survivors like Mustapha have a remarkable success rate persuading reluctant parents to vaccinate their children — on average, survivors convince seven of every ten parents they talk to. In places where misinformation and rumours have left people hesitant to vaccinate, the survivors’ role in the final phase of the eradication effort is critical.

“Since working with the team, I have seen an increase in immunization compliance in the community,” Mustapha says. “I am well-regarded in the community because of my work, and I am happy about this.”

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Three-year-old Madsa is carried by her sister after receiving a polio vaccine during a door-to-door campaign in Maroua, Cameroon. ©Gates Archive/Dominique Catton

ABU DHABI, 19 November 2019 – Today, global leaders convened at the Reaching the Last Mile (RLM) Forum in Abu Dhabi to affirm their commitment to eradicate polio and pledge US$2.6 billion as part of the first phase of the funding needed to implement the Global Polio Eradication Initiative’s Polio Endgame Strategy 2019-2023.

This pledging event comes on the heels of a major announcement last month that the world has eradicated two of the three wild poliovirus strains, leaving only wild poliovirus type 1 (WPV1) still in circulation. Additionally, Nigeria – the last country in Africa to have cases of wild polio – has not seen wild polio since 2016 and the entire WHO African region could be certified wild polio-free in 2020. Thanks to the dedicated efforts of health workers, governments, donors and partners, wild polio only circulates in two countries: Pakistan and Afghanistan.

“From supporting one of the world’s largest health workforces, to reaching every last child with vaccines, the Global Polio Eradication Initiative is not only moving us closer to a polio-free world, it’s also building essential health infrastructure to address a range of other health needs,” said Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization and Chair of the Polio Oversight Board. “We are grateful for the generous pledges made today and thank governments, donors and partners for standing with us. In particular, I would like to thank His Highness Sheikh Mohamed bin Zayed Al Nahyan, Crown Prince of Abu Dhabi for hosting the GPEI pledging moment and for his long-term support for polio eradication.”

The commitments announced today come at a critical time for the polio eradication effort. Barriers to reaching every child – including inconsistent campaign quality, insecurity, conflict, massive mobile populations, and, in some instances, parental refusal to the vaccine – have led to ongoing transmission of the wild poliovirus in Pakistan and Afghanistan. Further, low immunity to the virus in parts of Africa and Asia where not all children are vaccinated has sparked outbreaks of a rare form of the virus. To surmount these obstacles and protect 450 million children from polio every year, governments and donors announced significant new financial commitments toward the $3.27 billion needed to support the Polio Endgame Strategy.

Pledges are from a diverse array of donors, including: US$160 million from the host of the pledging moment His Highness Sheikh Mohamed bin Zayed Al Nahyan, Crown Prince of Abu Dhabi; countries, including US$215.92 million from the United States, US$160 million from the Islamic Republic of Pakistan, US$105.05 million from Germany, US$84.17 million from the Federal Government of Nigeria, US$10.83 million from Norway, US$10.29 million from Australia, US$7.4 million from Japan, US$2.22 million from Luxembourg, US$1.34 million from New Zealand, US$116,000 from Spain, and US$10,000 from Liechtenstein; GPEI partners, including US$1.08 billion from the Bill & Melinda Gates Foundation and US$150 million from Rotary International; philanthropic organizations, including US$50 million from Bloomberg Philanthropies, US$25 million from Dalio Philanthropies, US$15 million from the Tahir Foundation, US$6.4 million from the United Nations Foundation, US$2 million from Alwaleed Philanthropies, US$1 million from the Charina Endowment Fund, and US$1 million from Ningxia Yanbao Charity Foundation; and the private sector, including US$1 million from Ahmed Al Abdulla Group, US$1 million from Al Ansari Exchange, and US$340,000 from Kasta Technologies. Earlier this month, the United Kingdom announced it would contribute up to US$514.8 million to the GPEI.

“We are proud to host the GPEI pledging moment in Abu Dhabi and thank all the attendees for their continued commitment to the eradication of polio,” said Her Excellency Reem Al Hashimy, UAE Cabinet Member and Minister of State for International Cooperation. “Since launching in 2014, the Emirates Polio Campaign has delivered more than 430 million polio vaccines in some of the most remote areas of Pakistan. We remain firm in our mission to reach every last child and believe together we can consign polio to the pages of history.”

In addition to overcoming barriers to reach every child, this funding will ensure the resources and infrastructure built by the GPEI can support other health needs today and in the future. Polio workers deliver Vitamin A supplements, provide other vaccines like those for measles and yellow fever, counsel new mothers on breastfeeding, and strengthen disease surveillance systems to anticipate and respond to outbreaks. As part of its commitment to advance gender equality and women’s empowerment, the GPEI is also working to ensure equal participation of women at all levels of the programme.

The future of polio eradication hinges on support and engagement at all levels of the programme – from individuals to communities to local and national governments to donors. If the strategies needed to reach and vaccinate children are fully implemented and funded, we are confident that we can deliver a world where no child lives in fear of polio.

Pledge values are expressed in US dollars. View the full list of donors and pledge amounts.

Media contacts:

Oliver Rosenbauer

Communications Officer, World Health Organization

Email: rosenbauero@who.int

Tel: +41 79 500 6536

John Butler

Vice President, Global Health Strategies

Email: jbutler@globalhealthstrategies.com

Tel: +44 7502 203498

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Reposted with permission from Rotary.org.

Women and children collect water from a borehole in the Madinatu settlement, where about 5000 displaced people live. © Rotary International

This series looks at the ‘pluses’ that Rotarians worldwide help to provide. Our first article looked at prevention of other diseases. In part two, we look at another lifechanging intervention: providing clean water for communities.

Providing clean water

Addressing a critical long-term need such as access to clean water helps build relationships and trust with community members. Within camps for displaced people in northern Nigeria, the polio vaccinators who regularly visit communities are sometimes met with frustration. “People say, ‘We don’t have water, and you’re giving us polio drops,’” Tunji Funsho explains. Rotary and its partners have responded by funding 31 solar-powered boreholes to provide clean water in northern Nigeria, and the effort is ongoing.

Supplying clean water to vulnerable communities is a priority of the PolioPlus programme not only in Nigeria, but also in Afghanistan and Pakistan — the only other remaining polio-endemic nations, where transmission of the virus has never been interrupted.

Water, Sanitation, and Hygiene (WASH) and polio eradication efforts go together. © Rotary International

“Giving water is noble work also,” says Aziz Memon, chair of Rotary’s Pakistan PolioPlus Committee.

Access to safe drinking water is also an important aspect of the The Polio Endgame Strategy 2019-2023, which aims to “ensure populations reached for polio campaigns are also able to access much-needed basic services, such as clean water, sanitation, and nutrition.” The poliovirus spreads through human waste, so making sure people aren’t drinking or bathing in contaminated water is critical to eradicating the disease. Bunmi Lagunju, the PolioPlus project coordinator in Nigeria, says that installing the boreholes has helped prevent the spread of cholera and other diseases in the displaced persons camps.

Communities with a reliable source of clean water have a reduced rate of disease and a better quality of life. “When we came [to the camp], there was no borehole. We had to go to the nearby block factory to get water, and this was difficult because the factory only gave us limited amounts of water,” says Jumai Alhassan, as she gives her child a bucket-bath. “We are thankful for people who provided us with the water.”

By looking holistically at the needs of communities, Rotarians are ending polio, and making a significant contribution to overall health.

This story is part of the Broader Benefits of Polio Programme series on our website, which originally appeared in the October 2019 issue of The Rotarian magazine. Read part one.

The polio eradication campaign needs your help to reach every child. Thanks to the Bill & Melinda Gates Foundation, your contribution will be tripled. To donate, visit endpolio.org/donate.

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Seven-month-old Abdihakim Osman receives double doses of the oral polio vaccine during a national immunization campaign in Hargeisa, Somaliland. G20 members are some of the most committed supporters of polio eradication efforts. ©WHO/Ilyas Ahmed

G20 Health Ministers met in Okayama, Japan, on 19 and 20 October 2019 to address major global health issues in order to pave the way towards a more inclusive and sustainable world, as envisioned in the 2030 Agenda for Sustainable Development.

Ministers put a strong emphasis on ending polio in the resulting declaration, reaffirming their “commitment to eradicate polio”, and recognizing the remaining challenges.

Ministers welcomed next month’s pledging event. With the support of G20 members and other important global donors, the Global Polio Eradication Initiative aims to successfully raise funds to overcome the remaining challenges that face the world as we work to end polio. The pledging event will be generously hosted by the UAE and His Highness Sheikh Mohamed bin Zayed Al Nahyan, Crown Prince of the Emirate of Abu Dhabi, as part of the Reaching the Last Mile Forum on 19 November 2019, and intends to secure the financial commitments needed for the programme to finish the job.

Ministers noted, “We are concerned with the rising number of vaccine-derived polio outbreaks. We call for a strong cross-border cooperation and strict implementation of vaccine requirements for travelers as specified in the International Health Regulations (IHR, 2005).”

The polio programme is currently responding to vaccine-derived poliovirus outbreaks in 18 countries. The encouragements of the G20 Health Ministers regarding the pledging event, IHR implementation and cross-border collaboration are welcomed as part of measures to ensure high quality comprehensive outbreak response and the ability of the programme to eradicate the virus.

In addition, Ministers expressed support for “the efforts of the Global Polio Eradication Initiative (GPEI), Gavi, the Vaccine Alliance (Gavi), WHO, UNICEF, and other stakeholders in strengthening routine and supplemental immunization,” and highlighted the “leadership role of WHO”. This year, Gavi has joined the Polio Oversight Board, becoming the sixth partner of the initiative. Ministers referred to the importance of “the transition of relevant polio assets” to other health programmes, a process that will be strengthened by Gavi’s partnership.

Polio eradication has an important role to play in the implementation of other global health goals. Considering this broader context, Ministers recognized that “high quality and safe primary health care including access to vaccination is a cornerstone for UHC”. Ministers noted, “We recognize that immunization is one of the most cost-effective health investments with proven strategies that make it accessible to all segments of the population with an emphasis on women and girls, the most hard-to-reach as well as the vulnerable and marginalized populations. We express our concern about vaccine hesitancy as mentioned in the WHO’s Ten threats to global health in 2019.”

Vaccination is the only way to eradicate polio and the GPEI is working tirelessly in some of the most challenging contexts to ensure all children, boys and girls, regardless of where they live, have access to life-saving vaccines.

This important statement from G20 Ministers of Health represents a continuation of the strong historical political support for polio eradication from both the G7 and the G20, at the highest levels.

The statement also follows the reaffirmation of support for polio eradication by G20 health leaders during their June 2019 summit. In this meeting, they discussed major challenges facing the world and once more communicated that “we reaffirm our commitment to eradicate polio”.

In 2020, Saudi Arabia will hold the presidency of the G20 and the US Government will hold the Presidency of the G7.

The Government of Japan, current host of the G20, is committed to the eradication of polio, providing US$ 563 million in grants to the GPEI since 1988.

Read the Okayama Declaration of the G20 Health Ministers.

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Professor David Salisbury, chair of the independent Global Commission for the Certification of Poliomyelitis Eradication, presenting the official certificate of WPV3 eradication to Dr Adhanom Ghebreyesus. ©WHO

25 October 2019, Geneva, Switzerland

My fellow Polio Eradicators,

Yesterday was World Polio Day, a global awareness-raising day on the need to complete the job of polio eradication, and here at the World Health Organization (WHO) headquarters, it was my great honour to make a truly phenomenal announcement: that wild poliovirus type 3 has been certified as globally eradicated, by the Global Commission for the Certification of Poliomyelitis Eradication.

This is the second of the three types of wild poliovirus to have been globally eradicated. Only wild poliovirus type 1 remains in circulation, in just two countries worldwide. Africa has not detected any wild poliovirus of any type since September 2016, and the entire African Region is eligible to be certified free of all wild poliovirus next June.

Global wild poliovirus type 3 eradication is a tremendous achievement and is an important milestone on the road to eradicate all poliovirus strains. This shows us that the tactics are working, as individual family lines of the virus are being successfully knocked out.

But the job is not finished until ALL strains of poliovirus are fully eradicated – and stay eradicated. We must achieve final success or face the consequences of renewed global resurgence of this ancient scourge. We must eradicate the remaining strains of WPV1 and also address the increasing circulating vaccine-derived poliovirus outbreaks, in particular in Africa.

And here too we are making strong inroads. New strategies are helping us reach the most vulnerable populations, particularly in the remaining reservoir areas. New tools, including a brand-new vaccine, are being developed, to ensure the long-term risk of vaccine-derived polioviruses can be comprehensively addressed.

But these tools and tactics only work if they are fully funded, and fully implemented.

And so today, on the day after this tremendous announcement, I really have two messages for you.

The first is a simple and whole-hearted ‘thank you’. Thank you for making a world free of wild poliovirus type 3 a reality. Thank you to all countries, to all donors, to all stakeholders, partners, advisory and oversight groups, policy makers, Rotarians. Most importantly, thank you to all communities, to all parents. To all frontline health workers. They are the real heroes of this achievement.

And my second message is: please do not stop now. The Reaching the Last Mile Forum, hosted in the United Arab Emirates this November by His Highness Sheikh Mohamed bin Zayed Al Nahyan, Crown Prince of the Emirate of Abu Dhabi, will provide an opportunity for many of our stakeholders to recommit their efforts to a polio-free world. I urge all of you to stay committed and redouble determination in this final push to the finish line.

Together, the partners of the Global Polio Eradication Initiative (GPEI) – WHO, Rotary International, the US Centers for Disease Control and Prevention, UNICEF, the Bill & Melinda Gates Foundation and Gavi, the Vaccine Alliance – stand ready to support this global effort. But it will take collective and global collaboration, from all public- and private-sector stakeholders, to ensure every last child is reached and protected from all polioviruses.

Together, let us achieve history: let us ensure that no child anywhere will ever again by paralysed by any poliovirus.

Thank you.

Dr Tedros Ghebreyesus

Chair, GPEI Polio Oversight Board

Director-General, WHO

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Children showing off their marked fingers after vaccination. ©WHO/Sigrun Roesel

24 October 2019 – In a historic announcement on World Polio Day, an independent commission of experts concluded that wild poliovirus type 3 (WPV3) has been eradicated worldwide. Following the eradication of smallpox and wild poliovirus type 2, this news represents a historic achievement for humanity.

“The achievement of polio eradication will be a milestone for global health. Commitment from partners and countries, coupled with innovation, means of the three wild polio serotypes, only type one remains,” said Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization and Chair of the Global Polio Eradication Initiative (GPEI) Polio Oversight Board “We remain fully committed to ensuring that all necessary resources are made available to eradicate all poliovirus strains. We urge all our other stakeholders and partners to also stay the course until final success is achieved,” he added.

There are three individual and immunologically-distinct wild poliovirus strains: wild poliovirus type 1 (WPV1), wild poliovirus type 2 (WPV2) and wild poliovirus type 3 (WPV3). Symptomatically, all three strains are identical, in that they cause irreversible paralysis or even death. But there are genetic and virologic differences which make these three strains three separate viruses that must each be eradicated individually.

WPV3 is the second strain of the poliovirus to be wiped out, following the certification of the eradication of WPV2 in 2015. The last case of WPV3 was detected in northern Nigeria in 2012. Since then, the strength and reach of the eradication programme’s global surveillance system has been critical to verify that this strain is truly gone. Investments in skilled workers, innovative tools and a global network of laboratories have helped determine that no WPV3 exists anywhere in the world, apart from specimens locked in secure containment.

At a celebration event at the headquarters of the World Health Organization in Geneva, Switzerland, Professor David Salisbury, chair of the independent Global Commission for the Certification of Poliomyelitis Eradication, presented the official certificate of WPV3 eradication to Dr Adhanom Ghebreyesus. “Wild poliovirus type 3 is globally eradicated,” said Professor Salisbury. “This this is a significant achievement that should reinvigorate the eradication process and provides motivation for the final step – the eradication of wild poliovirus type 1. This virus remains in circulation in just two countries: Afghanistan and Pakistan. We cannot stop our efforts now: we must eradicate all remaining strains of all polioviruses. We do have good news from Africa: no wild poliovirus type 1 has been detected anywhere on the continent since 2016 in the face of ever improving surveillance. Although the region is affected by circulating vaccine-derived polioviruses, which must urgently be stopped, it does appear as if the continent is free of all wild polioviruses, a tremendous achievement.”

Eradicating WPV3 proves that a polio-free world is achievable. Key to success will be the ongoing commitment of the international development community. To this effect, as part of a Global Health Week in Abu Dhabi, United Arab Emirates, in November 2019, the Reaching the Last Mile Forum will focus international attention on eradication of the world’s deadliest diseases and provide an opportunity for world leaders and civil society organizations, notably Rotary International which is at the origin of this effort, to contribute to the last mile of polio eradication. The GPEI 2019–2023 Investment Case lays out the impact of investing in polio eradication. The polio eradication efforts have saved the world more than US$27 billion in health costs since 1988. A sustained polio-free world will generate further US$14 billion in savings by 2050, compared to the cost countries would incur for controlling the virus indefinitely.

The GPEI is a public-private global effort made up of national governments, partners including the World Health Organization, Rotary International, the US Centers for Disease Control and Prevention, UNICEF, the Bill & Melinda Gates Foundation and a broad range of long-term supporters.

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Reposted with permission from Rotary.org

When we talk about PolioPlus, we know we are eradicating polio, but do we realize how many added benefits the programme brings? The “plus” is something else that is provided as a part of the polio eradication campaign. It might be a hand-operated tricycle or access to water. It might be additional medical treatment, bed nets, or soap. This series takes a look at the ‘Pluses’, starting with prevention of other diseases. A 2010 study estimates that vitamin A drops given to children at the same time as the polio vaccine had at that time already prevented 1.25 million deaths by decreasing susceptibility to infectious diseases.

We take you to Nigeria, which could soon be declared free of wild poliovirus, to show you some of the many ways the polio eradication campaign is improving lives.

Health workers in Maiduguri, Borno State, tallying vaccine count. ©Rotary International

Polio vaccination campaigns are difficult to carry out in northern Nigeria, where insurgency has displaced millions of people, leading to malnutrition and spikes in disease. When security allows, health workers diligently work to bring the polio vaccine and other health services to every child, including going tent to tent in camps for displaced people.

The Global Polio Eradication Initiative (GPEI), of which Rotary is a spearheading partner, funds 91% of all immunization staff in the World Health Organization’s Africa region. These staff members are key figures in the fight against polio — and other diseases: 85% give half their time to immunization, surveillance, and outbreak response for other initiatives. For example, health workers in Borno use the polio surveillance system, which detects new cases of polio and determines where and how they originated, to find people with symptoms of yellow fever. During a 2018 yellow fever outbreak, this was one of many strategies that resulted in the vaccination of 8 million people. And during an outbreak of Ebola in Nigeria in 2014, health workers prevented that disease from spreading beyond 19 reported cases by using methods developed for the polio eradication campaign to find anyone who might have come in contact with an infected person.

Hurera Idris is installing insecticide-treated bed nets in her home. ©Rotary International

Children protected from polio still face other illnesses. In Borno, malaria kills more people than all other diseases combined. To prevent its spread, insecticide-treated bed nets — such as the one Hurera Idris is pictured installing in her home above — are often distributed for free during polio immunization events. In 2017, the World Health Organization organized a campaign to deliver antimalarial medicines to children in Borno using polio eradication staff and infrastructure. It was the first time that antimalarial medicines were delivered on a large scale alongside the polio vaccine, and the effort reached 1.2 million children.

Rotary and its partners also distribute soap and organize health camps to treat other conditions. “The pluses vary from one area to another. Depending on the environment and what is seen as a need, we try to bridge the gap,” says Tunji Funsho, chair of Rotary’s Nigeria PolioPlus Committee. “Part of the reason you get rejections when you immunize children is that we’ve been doing this for so long. In our part of the world, people look at things that are free and persistent with suspicion. When they know something else is coming, reluctant families will bring their children out to have them immunized.”

Rotarians’ contributions to PolioPlus help fund planning by technical experts, large-scale communication efforts to make people aware of the benefits of vaccinations, and support for volunteers who go door to door.

Fatima Umar, a volunteer, is educating Hadiza Zanna about health topics such as hygiene and maternal health, in addition to why polio vaccination is so important. ©Rotary International

Volunteer community mobilizers are a critical part of vaccination campaigns in Nigeria’s hardest-to-reach communities. The volunteers are selected and trained by UNICEF, one of Rotary’s partners in the GPEI, and then deployed in the community or displaced persons camp where they live. They take advantage of the time they spend connecting with community members about polio to talk about other strategies to improve their families’ health.

Nigerian Rotarians have been at the forefront of raising support for Rotary’s polio efforts. For example, Sir Emeka Offor, a member of the Rotary Club of Abuja Ministers Hill, and his foundation collaborated with Rotary and UNICEF to produce an audiobook called Yes to Health, No to Polio that health workers use.

This story is part of the Broader Benefits of Polio Programme series on our website, which originally appeared in the October 2019 issue of The Rotarian magazine.

The polio eradication campaign needs your help to reach every child. Thanks to the Bill & Melinda Gates Foundation, your contribution will be tripled. To donate, visit endpolio.org/donate.

The Emirates Polio Campaign works with communities at risk for polio. Through coordinated efforts, the Campaign provides vaccines along with food aid, sanitation and infrastructure projects. © WHO — The Emirates Polio Campaign works with communities at risk for polio. Through coordinated efforts, the Campaign provides vaccines along with food aid, sanitation and infrastructure projects. Photo courtesy Reaching the Last Mile

On 9 September 2019, the Global Polio Eradication Initiative (GPEI) partners and the United Arab Emirates co-hosted an informal reception as a pre-event ahead of the Polio Pledging Moment in the United Arab Emirates’-hosted Reaching the Last Mile Forum in Abu Dhabi, in November 2019. The GPEI also presented the 2019-2023 GPEI Investment Case.

The reception brought together GPEI stakeholders including, Rotary International, His Excellency Obaid Saleem Saeed Al Zaabi, UAE Permanent Representative to the United Nations (UN), representatives from the UAE; WHO Director-General and Chair of the GPEI Polio Oversight Board, Dr Tedros Adhanom Ghebreyesus; partners, and representatives from donor countries.

Following the GPEI Endgame Strategy 2019-2023, which spells-out a comprehensive five-year plan to ‘finish the job,’ the 2019-2023 Investment Case presents an economic case for investing in polio eradication as an important public health cause. Committing to eradication and achieving the goal of reaching every last child with the polio vaccine, an estimated US$ 14 billion are expected in cumulative cost savings by 2050, with efforts to eradicate polio having already saved more than US$27 billion since 1988. The need of the hour now is a bold financial and political commitment from leaders, donors, and governments around the world to rally behind a polio-free future.

As the GPEI launches its new investment case for 2019-2023, it recognizes important stakeholders who have gotten the programme to where it is today. One of the most notable donors is His Highness Sheikh Mohamed bin Zayed Al Nahyan, Crown Prince of Abu Dhabi.

His Highness Sheikh Mohamed bin Zayed has been a critical partner and champion of the GPEI. His support has helped spur significant progress toward stopping polio in the remaining endemic countries, with a specific focus on strengthening immunization efforts in Pakistan and Afghanistan. In 2018, the GPEI was proud to announce that His Highness’ support for polio eradication activities through the GPEI and the UAE Pakistan Assistance Programme and helped deliver 417 million vaccines to protect some of the most vulnerable and hard-to-reach children in the highest risk districts across the country.

WHO-DG and Chair of the GPEI Polio Oversight Board, Dr Tedros Adhanom Ghebreyesus, sharing a candid moment with His Excellency Obaid Saleem Saeed Al Zaabi, UAE Permanent Representative to the United Nations (UN). ©WHO

Starting off the reception, His Excellency Obaid Saleem Saeed Al Zaabi, UAE Permanent Representative to the United Nations (UN), gave insight into the UAE’s long-standing commitment to polio eradication efforts: “UAE, together with its partners, has played a leading role in polio eradication, has supported the delivery of vaccines to protect over 16 million children…and supported polio outbreak efforts in Afghanistan, Pakistan, Somalia, Ethiopia, Kenya and Sudan. For the implementation of the GPEI Endgame Strategy 2019-2023, which aims for a world free of wild poliovirus, the UAE in cooperation with the WHO will host a pledging event in Abu Dhabi in November 2019.”

WHO Director-General and Chair of the GPEI Polio Oversight Board, Dr Tedros Adhanom Ghebreyesus, also recognized the strong political and financial will of the donors —spanning over decades— which have helped the GPEI mark important milestones on the road to global polio eradication. “We have made good progress in accessing hard-to-reach communities…increasing cross-border efforts, enhancing surveillance, improving Supplementary Immunization Activities (SIAs), and focusing on social and behavioural change.”

“Unfortunately, we have seen an increase in the number of cases this year. This is a reminder that polio eradication is not a forgone conclusion…the last mile is the hardest. This will take a determined and unrelenting effort from all of us. Global progress to end polio would not be possible without partners like the UAE. On behalf of our partners at the GPEI, I would like to thank His Highness, Sheikh Mohammed bin Zayed Al Nahyan, Crown Prince of the Emirate of Abu Dhabi, and the UAE – a long-time supporter of the polio programme – for agreeing to host the GPEI pledging event on 19 November.”

Judith Diment, Chair of Rotary International Polio Eradication Advocacy Task Force, presenting the GPEI 2019-2023 Investment Case. © WHO

Rounding off the event, Chair of Rotary International Polio Eradication Advocacy Task Force, Judith Diment, officially presented the GPEI 2019-2023 Investment Case and called for concerted global efforts —both political and financial— to ensure that the hard-won gains in the fight against polio see us through the finish line. “Building on past progress and overcoming remaining hurdles requires continued support and (polio eradication) is a sound value-added investment. Today, we are proud to present the new 2019-2023 GPEI Investment Case…and thank all our partners for their input. This support and engagement are invaluable, given that this is a document that argues that polio can be eradicated but only with sufficient financial and political support. To ensure success, the Initiative needs US$ 3.27 billion through 2023… any investor is looking for measurable progress, tangible dividends, and return on investment— the GPEI has all of these. Rotary looks forward to joining all partners to make a funding pledge in Abu Dhabi, and to continued collaboration towards the fulfilment of a polio-free world from which we will all reap the dividends in perpetuity.”

The informal reception serves as a pre-event to the Reaching the Last Mile (RLM) Forum in November 2019, which will convene global health leaders to find solutions, best practices and eradication strategies to the most pressing health concerns of our times, including the global eradication of poliovirus. On the sidelines, the GPEI will also be hosting the Polio Pledging Moment to secure funding for the implementation of the Polio Endgame Strategy 2019-2023.

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At the G20 Osaka Summit 2019, leaders continue historical support. ©G20

In Osaka, Japan, G20 Leaders met on 28-29 June 2019, and discussed major challenges facing the world and the importance of eradicating polio. The G20 declaration states, “We reaffirm our commitment to eradicate polio as well as to end the epidemics of AIDS, tuberculosis and malaria and look forward to the success of the sixth replenishment of the Global Fund to fight AIDS, Tuberculosis, and Malaria.”

The pledging event of the Global Polio Eradication Initiative will be hosted by the UAE in November 2019 to ensure full financing and implementation of the efforts to finish the job.

There has been strong historical political support for polio eradication from both the G7 and the G20, at leaders- and Ministers of health-levels.

The G20 Declaration outlines that “Primary healthcare, including access to medicines, vaccination, nutrition, water and sanitation, health promotion and disease prevention is a cornerstone for advancing health and inclusion.”

The Japanese Presidency has been promoting a powerful global health agenda, both during its G7 Presidency in 2016 and this year at the G20, as a recognition that health is a prerequisite for sustainable and inclusive economic growth. Japan’s leadership has focused on Universal Healthcare Coverage (UHC) and demonstrated essential linkages with programmes contributing to health systems strengthening, and forming integral part of primary health care, including routine immunization and polio eradication.

Japan will be leading the organization of the United Nations General Assembly (UNGA) high-level meeting on UHC in September 2019 and the consultation process to finalize the political declaration “UHC: Moving Together to Build a Healthier World”.

In addition to the G20 Health Ministers meeting in Okayama in October 2019, Japan will also organize the Tokyo International Conference on African Development (TICAD) in Yokohama in the summer 2019, during which it will host the replenishment launch of Gavi, the Global Polio Eradication Initiative’s newest partner.

Read more: G20 Osaka Leaders’ Declaration

Marking the finger with indelible ink, an-all important part of the polio immunization activity. ©WHO/Nigeria

“We had not seen vaccination teams in our community for a very long time. Sometimes we go for months without vaccinating our children, if we don’t take our children to the mainland to get them vaccinated”, says Mr. Atebakuro Oton George, a fisherman and father of five, residing in Minibie ward of Nigeria’s Bayelsa State.

A largely riverine state, Bayelsa accounts for over 60% of the delta mangrove of the Niger Delta. Many children here continue to miss their chances at life-saving vaccination, as transport is precarious in the tangle of creeks and rivers that crisscross the state. In 2018 a number of innovative strategies such as, immunization boats at sea and community engagement through the traditional hierarchy and sensitization activities, supported by World Health Organization (WHO) through the Government of Bayelsa were introduced to reach a wider net of children.

“Now on weekly basis, health workers brave the seas and visit our communities to vaccinate our children”, an elated Mr. George continues.

Subsistence farming and fishing are the mainstay of the local population’s economy and diet. Health services are provided by primary health care centers located within the island communities.

“The difficulty of accessing healthcare services is due to suboptimal and expensive coastal and waterway transportation from the distant communities to healthcare centers, hence, innovative strategies are being employed to reach the underserved and vulnerable population with vaccination and other health interventions especially during Supplemental Immunization Activities (SIAs)”, says Dr Edmund Egbe, WHO State Coordinator in Bayelsa.

To reach ‘missed’ children, community engagement activities to increase demand for immunization have been initiated to bolster willingness of caregivers to readily access the interventions even when in the middle of the river or the ocean. The successful implementation of the community engagement framework has resulted in high-level acceptance of immunization services in the State. From April 2018 to April 2019, over 169 836 children received vaccination.

Routine immunization coverage has improved remarkably: the first quarter RI Lot Quality Assurance Survey (LQAS)— a quarterly activity organized by the National Emergency Routine Immunization Coordinator Centre (NERICC) to assess routine immunization performance, reasons for non-immunization as well as efforts to improve uptake and utilization of RI in Nigeria—conducted in April 2019 indicate that the State is second best in the country. Previously, the State was ranked amongst others in the country as poor-performing from the last National Immunization Coverage Survey (NICS) conducted in 2016; this led to the inauguration of an emergency response committee in March 2018.

King Diete-Spiff, the Chairman and the ‘Amanayanbo’ of Town-Brass, in his meeting with the State Traditional Rulers Council said, “Sustaining the innovative strategies of vaccinating vulnerable populations will undoubtedly increase immunity against vaccine preventable diseases and reduce the mortality and morbidity rate in difficult to access communities”. He described the polio infrastructure in Bayelsa, supported by WHO and partners, as the bedrock of driving successful healthcare intervention at the grassroots.

Support for polio eradication and routine immunization to Nigeria through WHO is made possible by funding from the Bill & Melinda Gates Foundation, the Department for International Development (DFID – UK), the European Union, Gavi, the Vaccine Alliance, the Government of Germany through KfW Bank, Global Affairs Canada, the United States Agency for International Development (USAID), Rotary International and the World Bank.

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72nd World Health Assembly. ©WHO/L.Cipriani

Polio eradication was in high-level spotlight this week in the top echelons of global leadership as World Health Organization (WHO) Member States, donors, partners, civil society organizations, health and development actors gathered this week at the 72^nd World Health Assembly (WHA) in Geneva, Switzerland.

In his opening address to delegates, WHO Director-General and Chair of the Polio Oversight Board (POB), Dr Tedros Adhanom Ghebreyesus talked about the long-winding journey of polio eradication since its adoption as a landmark resolution at the WHA in 1988 and the hopes of finishing eradication in the near future: “Together with our partners at Rotary, CDC, UNICEF, the Bill & Melinda Gates Foundation and Gavi, the Vaccine Alliance in the Global Polio Eradication Initiative, we have launched a new strategy to address the most difficult remaining areas in Afghanistan and Pakistan. Earlier this year I came across a video of a man called Irfanullah, wading through snow to deliver polio vaccines in Pakistan. With the dedication and commitment of people like him, I have no doubt we will succeed in making polio history.”

Member States expressed overwhelming support of the Polio Endgame Strategy 2019-2023. The new strategy sets the stage for a decisive win against polio through the parallel pursuit of the wild poliovirus and circulating vaccine-derived poliovirus. The Strategic Plan incorporates collaboration with other health interventions, fostering stronger alliances and managerial innovations by working in close coordination with governments in endemic countries. The Member States welcomed the trifecta of Eradication, Integration, and Containment/Certification, which set the foundations of a sustainable polio-free world by anchoring polio activities within the broader immunization system, ensuring an effective transition of eradication knowledge and assets and ensuring that no poliovirus can paralyze children again.

With an eye towards an inclusive and sustainable polio-free future, there was broad consensus that all stakeholders—governments, GPEI partners, private and public donors, policy makers, health, and non-health actors— are in this together. One of the recurring themes was the need to ensure concerted efforts—financial and programmatic— to get over the hump in this last mile over to the finish line.

The general air was that of cautious optimism, as all Member States acknowledged that the path to finishing polio eradication is well within sight, all thanks to the Endgame Plan 2013-2018 which succeeded in certifying South-East Asia (SEARO) as polio-free, brought the African Region closer than ever to eradication of wild poliovirus, possibly eradicated two out of three wild poliovirus strains, set the world on the path of phased Oral Polio Vaccine (OPV) removal, stopped outbreaks in Syria and Horn of Africa, and cornered wild poliovirus circulation to a joint cross-border reservoir between Afghanistan and Pakistan.

The delegates particularly appreciated the strong commitments espoused by Afghanistan and Pakistan for a more systematic collaboration to jointly target the common wild poliovirus reservoir on all fronts with an approach that combines the scientific with the social and anthropological. Pakistan’s representative said, “We remain resolute with the highest level of political commitment… strengthening routine immunization, addressing prevalent malnutrition, and provision of safe water and sanitation are strategies being implemented in tandem. Communication challenges of low-risk perception and concerns around vaccine safety and efficacy are being addressed through a revised communication strategy. We continue to coordinate with Afghanistan programme to share experience in strategies to manage the common epidemiological block. In light of the recent cases, the Government of Pakistan has decided to carry out a comprehensive programme review on an urgent footing. I would like to sincerely thank our partners and donors who are a part of this initiative and helped us get this far. We pledge our complete commitment to reach every last child, so no future generations have to suffer from a crippling disease like polio.”

Rotary International, one of the pioneering partners of the GPEI, maintained that wild poliovirus eradication remains the overriding priority, and to that end, re-affirmed collective commitment of their 1.2 million members around the world: “It is easy to forget the hurdles we have overcome—such as: addressing outbreaks in more than 20 countries in Africa, or how India had 80% burden of the total polio caseload in the world. Our challenge is not feasibility, but determination…global commitment has brought us to the threshold of a polio-free world. Let us act with urgency to end polio forever.”

In his closing remarks, Dr Tedros thanked the Crown Prince of Abu Dhabi and the United Arab Emirates for hosting a pledging moment for the Global Polio Eradication Initiative, “Global progress to end polio would not be possible without partners like the UAE. I would like to thank His Highness Sheikh Mohamed bin Zayed Al Nahyan, Crown Prince of Abu Dhabi, and the UAE – a long-time supporter of the polio programme – for agreeing to host the GPEI pledging event this November at the Reaching the Last Mile Forum, a gathering of leaders from across the global health space.”

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Dr Rebecca Martin, Centers for Disease Control and Prevention, delivering the welcome address at the event ”To succeed by 2023—Reaching Every Last Child for a Polio-free World” to celebrate the launch of the Polio Endgame Strategy 2019-2023. ©WHO.

The 72^nd World Health Assembly, the governing body of the World Health Organization held by in Geneva, Switzerland is the biggest congregation of public health actors. Taking advantage of the critical mass of global leaders, the Global Polio Eradication Initiative hosted an event for polio eradicators, partners and stakeholders on 21 May 2019.

The event, To Succeed by 2023—Reaching Every Last Child, celebrated the GPEI’s new Polio Endgame Strategy 2019-2023. The five-year plan spells out the tactics and tools to wipe out the poliovirus from its last remaining reservoirs, including innovative strategies to vaccinate hard-to-reach children and expanded partnerships with the Expanded Programme on Immunization (EPI) community and health emergencies.

The informal event brought together a cross-section of stakeholders – partners, health actors, non-health actors, supporters, donors, Ministers of Health of endemic countries, WHO Regional Director for the Eastern Mediterranean, and Polio Oversight Board members – alluding to strengthened and systematic collaboration in areas of management, research and financing activities in the last mile.

Dr Zafar Mirza, Pakistan’s Minister of State,Ministry of National Health Services, Regulations, and Coordination, seen with Seth Berkley, CEO of Gavi, the Vaccine Alliance, at the GPEI informal event during the 72nd World Health Assembly. ©WHO

Dr Zafar Mirza, Pakistan’s Minister of State,Ministry of National Health Services, Regulations and Coordination, took the stage and gave insight into country-level polio eradication efforts and the need for coordinated action with Afghanistan: “20 years ago, 30 000 children were paralyzed by polio in Pakistan. This year, 15 cases have been reported. While we have done a lot, it is clearly not enough. We are resolute in this conviction. We, together with Afghanistan, must make sure we eradicate polio for the sake of our children. Our science is complete, only our efforts are lacking. Along with the polio programme, the donors and the Afghan government, we will get to the finish line.”

Echoing similar sentiments, Dr Ferozuddin Feroz, Minister of Public Health of Afghanistan, said, “I would like to start by expressing thanks to all the partners for their support. As you know, Afghanistan has a very challenging context due to inaccessibility, refusals, gaps in campaign quality, low routine immunization coverage, and extensive cross-border movement. But, Afghanistan has made progress—five out of seven regions continue to maintain immunization activities. We view polio as a neutral issue and have developed a robust National Emergency Action Plan 2019. We appreciate the Polio Endgame Strategy 2019-2023. We believe coordination with Pakistan will help us deliver a polio-free world. We look forward to your continued technical and financial support to achieve the goal of polio eradication.”

Dr Ferozuddin Feroz, Minister of Public Health, Afghanistan, talking about the remaining challenges for polio eradication and the need for continued partner support in the last mile. ©WHO

Recognizing the long-standing commitment of the United Arab Emirates, a video was played showing the on-ground efforts of the Emirates Polio Campaign, working with communities and families in Pakistan in collaboration with the Global Polio Eradication Initiative and partners, and the Government of Pakistan. Thanks to the Emirates Polio Campaign, 71 million Pakistani children have been reached with 410 million doses of polio vaccine.

Dr Abdullahi Garba, Director for Planning, Research and Statistics, National Primary Healthcare Development Agency spoke on behalf of Professor Isaac F Adewole, Federal Minister of Health of Nigeria. Dr Garba harked back to the past as the GPEI plans for the future: “Nigeria started actively working to eradicate polio in 1988, at a time when we used to have up to a thousand cases every year. With all our innovation and efforts, I am pleased to inform you today that no wild polio case has been detected for the past 33 months. This feat was achieved through continuous efforts between the government, GPEI and partners, having diligent incidence reporting, reaching inaccessible children, and improving the quality of the polio surveillance immunization activities through strong oversight mechanisms in Nigeria. I know I also speak on behalf of all countries across Africa – we will achieve success.”

Representing Nigeria, Dr Abdullahi Garba, Director for Planning, Research and Statistics, National Primary Healthcare Development Agency, talked about the challenges, innovations and tools used to bring Nigeria to the brink of polio eradication. ©WHO

Rounding off the evening, Dr Tedros Adhanom Ghebreyesus, the World Health Organization Director-General and Chair of the GPEI Polio Oversight Board, took the stage to recount his first visit of the year to the polio endemic countries of Afghanistan and Pakistan, the progress made over decades, and the need to re-commit to the cause of ending polio. “Together with Regional Director Ahmed Al-Mandhari and Chris Elias of the Gates Foundation, we travelled to Pakistan and Afghanistan. We saw first-hand the commitments by both public and civil society leaders, which gave us a lot of confidence. The other thing that gave us confidence was seeing our brave health workers trudging through deep snow. And of course, our partners: Rotary, United Arab Emirates, CDC, UNICEF, the Bill & Melinda Gates Foundation and Gavi. The last 30 years have brought us to the threshold of being polio-free…(which) lay out the roadmap that is the Polio Endgame Strategy 2019-2023. The Ministers of Afghanistan and Pakistan have also assured us that they will continue to work together in their shared corridor to finish polio once and for all.”

Dr Tedros Adhanom Ghebreyesus, the World Health Organization Director-General and Chair of the GPEI Polio Oversight Board, remains confident in continued political commitment in the endemic countries, the tireless support of partners, donors, and the Polio Endgame Strategy 2019-2023 to deliver a polio-free world. ©WHO

In 1988, the World Health Assembly passed a resolution to globally eradicate poliovirus, in what was meant to be “an appropriate gift…from the twentieth to the twenty-first century.”

As the GPEI plans for the future and its final push to ‘finish the job,’ it is clear that political and financial efforts need to ramp up in this increasingly steep last mile. As he concluded, Dr Tedros thanked committed partners like United Arab Emirates: “Global progress to end polio would not be possible without partners like the UAE. I would like to thank His Highness Sheikh Mohamed bin Zayed Al Nahyan, Crown Prince of Abu Dhabi, and the UAE – a long-time supporter of the polio programme – for agreeing to host the GPEI pledging event this November at the Reaching the Last Mile Forum, a gathering of leaders from across the global health space held once every two years…let us join together to end polio.”

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Reposted with permission from Rotary.org

International PolioPlus Committee Chair Mike McGovern. ©Rotary International

1. There were more cases of wild poliovirus in 2018 than in 2017. Should we be discouraged?

No, not at all. We’ve always expected the number of cases to fluctuate somewhat as we get closer to zero. We’ve gone four straight years with fewer than 100 cases per year. That’s an indicator of great progress. With dedication from governments and Rotarians in areas still affected by polio, we’ll get there.

2. Why is it so difficult to eradicate a disease like polio?

Remember that even in the United States, where the polio vaccine was readily available, it still took 20 years to become polio-free. And the areas we are working in now don’t have health systems that are as well-developed as in the United States.

3. What challenges are you seeing now?

We have been working intensely in the endemic countries — Afghanistan, Nigeria, and Pakistan — for a number of years, and some of the citizens in those countries are getting concerned that we are spending money on polio eradication when they have so many other needs. There’s some resistance to keep on receiving immunizations for polio, and polio alone. Our challenge is to find ways to provide other services to the citizens and children, so we still have the parental support we need — to provide the “plus” in PolioPlus.

4. What role does armed conflict play in those areas?

It makes the logistics of immunization far more difficult. The Global Polio Eradication Initiative partnership is not only dealing with governments — we’re dealing with anti-government elements as well. While we’ve worked to gain everyone’s trust and support, we’ve had areas that were inaccessible to immunization teams for months and sometimes years at a time.

National Immunization Day activities in New Delhi, India. ©Rotary International

5. Do immunization teams know when they miss children? Or are there children they don’t even know about?

I think we have a good handle now on knowing when and where we’re missing children. The challenge is to keep reducing the number we miss. In Nigeria, we have done a lot of work since the discovery of several polio cases in Borno state in 2016. But access, immunity levels and surveillance are much better today than they were in 2016, when we did detect those cases. We are cautiously optimistic.

6. Where are we seeing successes?

We haven’t had any cases of wild poliovirus anywhere in the world in nearly five years except in the three endemic countries. And in Nigeria, it’s been almost three years since we detected any wild poliovirus cases, and those occurred in a small area of the country. But we are not there yet. Complacency is one of our biggest enemies, and we cannot take our foot off the accelerator until success is achieved.

7. What’s the most important thing Rotarians should know?

I’ve been extremely impressed with the dedication and persistence of Rotarians in Afghanistan, Nigeria, and Pakistan. They are working hard to make sure polio is eradicated. It’s pretty amazing what they do in those countries.

Rotarians should continue to be optimistic and to support eradication. We also need Rotarians to bring the need for continued funding to the attention of their government leaders. We can’t lose sight of the goal.

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On 15 March 2019 in Islamabad, representatives from the Embassy of Japan and the Japan International Cooperation Agency (JICA) were given a general update on the progress of the Polio Regional Lab and the surveillance network. Thanks to Japan’s funding, 70% of the latest molecular biology equipment has been procured, installed and made operational. JICA representatives also toured the facility and the works in process.

Representatives from JICA and the Embassy of Japan touring the Pakistan Regional Polio Lab facilities. ©WHO/Pakistan

The Government of Japan through JICA is a long-standing and committed donor to the polio eradication efforts by funding initiatives and broader immunization activities in Pakistan since 1996.

As a part of its more recent commitment, JICA is supporting Pakistan in strengthening disease surveillance through a state-of-the-art equipment of the Regional Reference Laboratory at the National Institute of Health in Islamabad.

The Pakistan Regional Polio Lab will go a long way in facilitating poliovirus detection in stool samples and the environment. At present, the lab tests more than 30,000 stool samples from people with paralysis and 950 environmental samples each year, including samples from both Afghanistan and Pakistan. The new soon-to-be operational lab equipment will speed up the ability to process and respond quickly wherever the poliovirus may be hiding. This is critical work in ensuring Pakistan targets its last remaining core reservoirs of poliovirus.

In this last mile of polio eradication, support from JICA is crucial and much appreciated. Pakistan is one of the last remaining polio endemic countries in world, along with Afghanistan and Nigeria. The political and financial commitment from the Government of Japan over the years has already helped Pakistan in reducing the number of polio cases by 96% since 2014. With only 12 cases reported in 2018, Pakistan has a fighting chance of finally consigning polio to the history books.

The Japan International Cooperation Agency (JICA)

The Japan International Cooperation Agency (JICA) assists and supports developing countries as the executing agency of Japanese ODA. In accordance with its vision of “Inclusive and Dynamic Development,” JICA supports the resolution of issues of developing countries by using the most suitable tools of various assistance methods, such as technical cooperation, ODA loans and grant aid in an integrated manner.

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Reposted with permission from Rotary.org

Dr Ujala Nayyar dreams, both figuratively and literally, about a world that is free from polio. Nayyar, the World Health Organization’s surveillance officer in Pakistan’s Punjab province, says she often imagines the outcome of her work in her sleep.

In her waking life, she leads a team of health workers who crisscross Punjab to hunt down every potential incidence of poliovirus, testing sewage and investigating any reports of paralysis that might be polio. Pakistan is one of just two countries that continue to report cases of polio caused by the wild virus. In addition to the challenges of polio surveillance, Nayyar faces substantial gender-related barriers that can hinder her team’s ability to count cases and take environmental samples. From households to security checkpoints, she encounters resistance from men. But her tactic is to push past the barriers with a balance of sensitivity and assertiveness.

“I’m not very polite,” Nayyar says with a chuckle. “We don’t have time to be stopped. Ending polio is urgent and time-sensitive.”

Dr Ujala Nayyar during one of her field visits. © Rotary International

Women are critical in the fight against polio, Nayyar says. About 56% of frontline workers in Pakistan are women. More than 70% of mothers in Pakistan prefer to have women vaccinate their children.

That hasn’t stopped families from slamming doors in health workers’ faces, though. When polio is detected in a community, teams have to make repeated visits to each home to ensure that every child is protected by the vaccine. Multiple vaccinations add to the skepticism and anger that some parents express. It’s an attitude that Nayyar and other health workers deal with daily.

“You can’t react negatively in those situations. It’s important to listen. Our female workers are the best at that,” says Nayyar.

With polio on the verge of eradication, surveillance activities, which, Nayyar calls the “back of polio eradication”, have never been more important.

Q: What exactly does polio surveillance involve?

A: There are two types of surveillance systems. One is surveillance of cases of acute flaccid paralysis (AFP), and the second is environmental surveillance. The surveillance process continues after eradication.

Q: How are you made aware of potential polio cases?

A: There’s a network of reporting sites. They include all the medical facilities, the government, and the hospitals, plus informal health care providers and community leaders. The level of awareness is so high, and our community education has worked so well, that sometimes the parents call us directly.

Dr Ujala Nayyar, the surveillance officer for the World Health Organization in Punjab, Pakistan, navigates through barriers to hunt down cases of polio. © Rotary International.

Q: What happens if evidence of poliovirus is found?

A: In response to cases in humans as well as viruses detected in the environment, we implement three rounds of supplementary immunization campaigns. The scope of our response depends on the epidemiology and our risk assessment.

We look at the drainage systems. Some systems are filtered, but there are also areas that have open drains. We have maps of the sewer systems. We either cover the specific drainage areas or we do an expanded response in a larger area.

Q: What are the special challenges in Pakistan?

A: We have mobile populations that are at high risk, and we have special health camps for these populations. Routine vaccination is every child’s right, but because of poverty and lack of education, many of these people are not accessing these services.

Q: How do you convince people who are skeptical about the polio vaccine?

A: We have community mobilizers who tell people about the benefits of the vaccine. We have made it this far in the program only because of these frontline workers. One issue we are facing right now is that people are tired of vaccination. If a positive environmental sample has been found in the vicinity, then we have to go back three times within a very short time period. Every month you go to their doorstep, you knock on the door. There are times when people throw garbage. It has happened to me. But we do not react. We have to tolerate their anger; we have to listen.

Q: What role does Rotary play in what you do?

A: Whenever I need anything, I call on Rotary. Umbrellas for the teams? Call Rotary. Train tickets? Call Rotary. It’s the longest-running eradication program in the history of public health, but still the support of Rotary is there.

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Global health leaders at the opening session of the 144th Executive Board Meeting. © WHO

WHO Director-General Dr Tedros Adhanom Ghebreyesus opened the Organization’s Executive Board (EB) on 24 January with a report from his first visit of the year, to the polio endemic countries of Afghanistan and Pakistan: “This year I have taken over as chair of the Polio Oversight Board. That’s why my first trip of the new year was to Afghanistan and Pakistan. These are the two countries that are the last frontiers of wild poliovirus. We are so close to ridding humanity of this disease, and I am personally committed to ensuring that we do. I was really impressed by the commitment of the governments of Afghanistan and Pakistan.”

The Executive Board, comprised of 34 Member States’ designated experts in the field of health, convened in Geneva in late January to discuss a wide-ranging agenda on the most pressing and urgent health concerns of our times, including the urgency to rev up efforts in this last mile of polio eradication efforts.

The EB was encouraged by the progress achieved through the Endgame Strategic Plan 2013-2018, which has led the world to the brink of polio eradication and laid the groundwork for the new strategy – the Global Polio Eradication Initiative Strategic Plan 2019-2023. The new strategy will aim to sharpen the tools and tactics that led to the global progress in bringing down the case load from 350 000 annual wild polio virus cases in 1988 to only 33 cases in 2018. Success in the coming years will hinge on harnessing renewed financial and political support to fully implement the plan at all levels, with our one clear goal in sight: reach every last child with the polio vaccine to end this disease once and for all.

In a time of many global challenges and priorities, the coming year will require more than ever a singular commitment from the governments and partners as we near zero. On the sidelines of the EB, the DG held a stakeholder consultation to ensure that the 2019-2023 Strategic Plan reflects a transparent and inclusive stakeholder participation. The DG stressed the need for strengthened and systematic collaboration between partners, health, and non-health actors across cross-cutting areas of management, research and financing activities for polio eradication. Given that polio eradication effort continues to be a global priority, one of the salient features of the consultation was a renewed commitment to transparent long-term budgets for eradication efforts, including key post-certification costs such as stockpiles and inactivated polio vaccine to help protect more than 430 million children from polio each year.

“In a time of many global challenges and priorities, the coming year will require more than ever a singular commitment from the governments and partners as we near zero.”

Voicing similar sentiments earlier, Chairs of the effort’s main advisory bodies issued an extraordinary joint statement, urging all stakeholders, partners, countries, and individuals to strengthen their collective resolve to seeing polio fully eradicated for good. Polio continues to be a global health risk as confirmed at the end of last year, the Emergency Committee reiterated its advice that polio remains a public health emergency of international concern.

Polio resources for over three decades have helped reduce the number of endemic countries from 135 down to only 3 (Pakistan, Afghanistan, and Nigeria), eradicate polio from some of the most challenging areas in the world, and continue to enable countries around the world in advancing other national health goals.

With the continued commitment of all donors and partners, 2019 may very well become the decisive year when we finally stop wild polio virus transmission in Afghanistan and Pakistan.

The Endgame Plan through 2018 brought the world another year closer to being polio-free. While we had hoped to be finished by now, 2018 set the tone for the new strategic plan, building on the lessons learned and mapping out a certification strategy by 2023. 2018 was also marked by expanded efforts to reach children with vaccines, the launch of innovative tools and strategies, critical policy decisions and renewed donor commitment to the fight.

Dr Tedros Adhanom Ghebreysus, WHO Director General and Chair Polio Oversight Board, administering polio drops to a young child in Pakistan. WHO/Jinni — Dr Tedros Adhanom Ghebreysus, WHO Director General and Chair Polio Oversight Board, administering polio drops to a young child in Pakistan. © WHO/Jinni

Cornering wild poliovirus

Circulation of wild poliovirus (WPV) continues in the common epidemiological block in Afghanistan and Pakistan. However, both countries steadily worked to improve the quality of their vaccination campaigns in 2018 through National Emergency Action Plans, with a particular focus on closing any immunity gaps to put the countries on track to successfully stop WPV in the near future. Given the priority on polio eradication, WHO Director General, WHO Regional Director for the Eastern Mediterranean and President, Global Development at Bill & Melinda Gates Foundation started off the new year with a four-day visit to meet the heads of state and have a first-hand experience of the on-the-ground eradication efforts in both the countries.

In August, Nigeria marked two years since detecting any WPV. With continuing improvements in access to the country’s northeast, as well as efforts to strengthen surveillance and routine immunization, the entire African region may be eligible for being certified WPV-free as early as late this year or early 2020. What’s more, the world has not detected type 3 WPV since 2012 and the strain could be certified eradicated sometime this year.

Program innovation

The programme is constantly developing new ways to more effectively track the virus, vaccinate more children and harness new tools to help end the disease for good.
In Nigeria and the surrounding region, health workers launched new tools to enable faster, more comprehensive disease surveillance. e-Surve, a smartphone app, guides officers through conversations with local health officials, offering prompts on how to identify and report suspected cases of disease. Then, with the touch of a button, responses are submitted to a central database where health officials can analyze and track outbreaks across multiple districts in real-time.

Beyond surveillance, health workers worked tirelessly to bring the polio vaccine to the remote communities of Lake Chad. Dotted with hundreds of small islands, the lake is one of the most challenging places on earth to deliver health services. Vaccinators must travel by boat on multi-day trips to deliver polio vaccines to isolated island villages, using solar-powered refrigerators to keep their precious cargo cool. In 2018, vaccination campaigns on the lake reached thousands of children for the first time – children who would otherwise have gone unprotected.

Lake Chad Polio Task Team wave to polio vaccinators and community members on Ngorerom island, Lake Chad. © Christine McNab/UN Foundation

The programme also took important steps in developing new tools including, novel oral polio vaccine (nOPV), if studies show to be successful, could provide a safer form of OPV that provides the same level of protection without the small risk of vaccine-derived polio in under-immunized populations.

Battling circulating vaccine-derived poliovirus

In 2018, the Democratic Republic of the Congo, Niger, Nigeria, Papua New Guinea, Kenya, Somalia and Mozambique experienced outbreaks of circulating vaccine-derived polio (cVDPV). Although these cases are still rare – and only happen in places where immunity is low. The polio eradication initiative has two urgent tasks: eradicate WPV quickly as possible and stop the use of OPV globally, which in tandem will prevent new cVDPV strains from cropping up.

The program uses the same proven strategies for stopping wild polio in responding to cVDPV cases. These strategies, coupled with the rapid mobilization of resources on the ground, can bring outbreaks under control.

In December, an international group of public health experts determined that the 2017 cVDPV2 outbreak in Syria has been successfully stopped. This news follows 18 months of intensive vaccination and surveillance efforts led by the GPEI and local partners in conflict-affected, previously inaccessible areas. In Papua New Guinea, the programme carried out 100 days of emergency response this past summer and is continuing to vaccinate and expand surveillance across the country.

Bringing an end to ongoing cVDPV outbreaks remains an urgent priority for the program in 2019.

New policy decisions

At the World Health Assembly in May, Member States adopted a landmark resolution on poliovirus containment to help accelerate progress in this field and ensure that poliovirus materials are appropriately contained under strict biosafety and biosecurity handling and storage conditions. The programme also finalized a comprehensive Post-Certification Strategy that specifies the global, technical standards for containment, vaccination and surveillance activities that will be essential to maintaining a polio-free world in the decade following certification.

Recognizing the ongoing challenge posed by cVDPVs, the Global Commission for the Certification of Poliomyelitis Eradication (GCC) met in November and recommended an updated process for declaring the world polio-free. This plan will start with the certification of WPV3 eradication, followed by WPV1, and include a separate independent process to validate the absence of vaccine-derived polio.

Comprised of members, advisers, and invited Member States, the 19^th IHR Emergency Committee met in November. The Committee unanimously agreed that poliovirus continues to be a global emergency and complacency at this stage could become the biggest hindrance. “We have the tools, we need to focus on what works, we need to get to every child,” commented Prof. Helen Rees, Chairperson of the Committee. “The reality is that there is no reason why we should not be able to finish this job, but we have to keep at it.” “We have achieved eradication of a disease once before, with smallpox,” Rees concluded. “The world is a much better place without smallpox. It’s now more urgent than ever that we redouble our efforts and finish this job once and for all as well.”

Six-year old Gafo was the first polio case in Papua New Guinea in decades, which prompted a national emergency and an outbreak response. © WHO/PNG

Spotlight on gender

In 2018, the GPEI took major steps in adopting a more gender-responsive approach and strengthening gender mainstreaming across its interventions. The GPEI Gender Technical Brief highlighted the programme’s commitment to gender equality and included a thorough analysis of various gender-related barriers to immunization, surveillance and communication.

The programme introduced new gender-sensitive indicators to ensure that girls and boys are equally reached with polio vaccines, to track the timeliness of disease surveillance for girls and boys, and to monitor the rate of women’s participation as frontline workers in the endemic countries. The GPEI continues to regularly collect and analyze sex-disaggregated data and conduct gender analysis to further strengthen the reach and effectiveness of vaccination campaigns.

Donor and country commitments

Throughout 2018, political leaders around the world voiced their support for the programme’s efforts, including Prime Minister Trudeau, WHO Director General Dr Tedros, Prime Minister Theresa May, His Highness Sheikh Mohamed bin Zayed Al Nahyan and His Royal Highness Prince Charles. Leaders demonstrated commitment by advocating for a polio-free world at various global events, including the G7, G20, CHOGM, and the annual Rotary Convention.

Donor countries made new financial contributions to the programme in 2018. Polio-affected countries also demonstrated continued political commitment to eradication efforts. The Democratic Republic of the Congo signed the Kinshasa Declaration committing to improve vaccination coverage rates in sixteen provinces throughout the country, and Nigeria approved a $150 million loan from the World Bank to scale up immunization services and end polio.

Looking ahead: 2019 and beyond

Over the last five years, the programme has been guided by the 2013-2018 Polio Eradication & Endgame Strategic Plan, helping to bring the world to the brink of polio eradication. This spring, the programme will finalize a new strategy –GPEI Strategic Plan 2019-2023– which will aim to sharpen the tools and tactics that led to this incredible progress. In 2019, the GPEI will also launch its first-ever Gender Strategy to further guide its gender-responsive programming and to increase women’s meaningful and equal participation at all levels of the programme.

Success in the coming years will hinge on harnessing renewed financial and political support to fully implement the plan at all levels, with our one clear goal in sight: reach every last child with the polio vaccine to end this disease once and for all. Echoing similar sentiments, Chairs of the effort’s main advisory bodies issued an extraordinary joint statement, urging all to step up their performance to end polio. 2019 may very well be the watershed year that the world will finally eradicate polio, thanks to the global expertise and experience over 3 decades.

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Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization and Chair of the Polio Oversight Board, administering polio drops to a child during a four-day joint visit to Pakistan and Afghanistan. © WHO/Pakistan

For Dr Tedros Adhanom Ghebreyesus, Director-General of WHO, the start to the new year was marked with a four-day visit to Afghanistan and Pakistan from 5-8 January. The visit came at the heels of his new role as the Chair of the Polio Oversight Board (POB) on 1 January, a committee which oversees and guides the Global Polio Eradication Initiative, signalling the Board’s utmost commitment towards eradication of polio for good.

Accompanied by WHO Regional Director for the Eastern Mediterranean Dr Ahmed Al-Mandhari, Dr Tedros’ well-knit, compact visit covered a lot of bases from field visits to high-level meetings with heads of state from both the countries, giving the POB an opportunity to see that while polio may still be in endemic in Afghanistan and Pakistan, but the process to achieve the goal of ending polio is not far from realization.

“We must all give our best on this last mile to eradicate polio once and for all. My wish for 2019 is for zero polio transmission. You have WHO’s full support to help reach every child and stop this virus for good,” Dr Tedros said.

During his first stop in Afghanistan on 5-6 January, Dr Tedros met with His Excellency President Dr Ashraf Ghani, His Excellency Chief Executive Dr Abdullah Abdullah, the Council of Ministers, representatives of key partners and nongovernmental organizations working in the field of public health. He also visited to the WHO-supported Trauma Care Hospital in Kabul.

In Pakistan on 7-8 January, Dr Tedros met with the Prime Mister Imran Khan, Federal Minister for National Health Regulations & Coordination Mr Aamer, Mehmood Kiani, Minister of Foreign Affairs and Federal Minister for Human Rights Dr Shireen Mazari.

Dr Tedros accompanied the President of Pakistan, Arif Alvi, to the launch of the first Pakistan Nursing and Midwifery Summit and the Nursing Now campaign. He also visited a basic health centre in Shah Allah Ditta where WHO signed an agreement with the Government of Pakistan to develop a model health care system for universal health coverage in Islamabad.

In the last mile of the polio eradication journey, Dr Tedros’ visit serves as a reminder that now more than ever we need to have social, political and global will to make polio the second human disease in history to be wiped from earth.

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“On the way to global certification” was the theme of this year’s Regional Meeting on Polio, which convened on 6 December 2018 in Guatemala City. Pan American Health Organization (PAHO) urged collective action to not only ensure that there is no re-emergence of polio in the Americas, but also to lend support in the global fight against polio.

Cuauhtémoc Ruiz-Matus, Chief of the Comprehensive Family Immunization Unit at the Pan American Health Organization (PAHO), addressing the meeting. © WHO/PAHO

The last reported case of polio in the Americas was documented in 1991 and in 1994 the region became the first to be certified free of the disease. But that is not to say there is room for complacency. Echoing the Global Polio Eradication Initiative’s goal of a polio-free world, Cuauhtémoc Ruiz-Matus, Chief of the Comprehensive Family Immunization Unit at the Pan American Health Organization (PAHO) said, “As long as there is even one infected child, children in all countries are at risk of contracting polio,” during the inauguration.

With recent reports emerging that some of the countries in the Americas have vaccination coverage hovering below 95% — the minimum baseline required to prevent circulation — there is a real chance of outbreak through importation of virus or the emergence of circulating vaccine-derived poliovirus.

“We know that there is a risk of reintroduction of polio, which is why Guatemala has committed to adhere to PAHO’s strategic plan so that the Region remains polio-free,” said the Deputy Health Minister of Guatemala, Roberto Molina. The country recorded its last case of polio in 1990.

Participants at the 6th Regional Meeting on Polio in Guatemala. © WHO/PAHO

Reiterating the need for continued efforts, PAHO Representative in Guatemala, Oscar Barreneche, highlighted that “maintaining standards of surveillance, containment and response to outbreaks, and vaccination is key.”

As the world reaches closer to poliovirus eradication, the countries of the Americas will play an instrumental role in sustaining the momentum for the cause and preventing reintroduction of the disease in the continent.

Read about the meeting.