GPEI-Young women leaders: Keep dreaming high

Dr. Ana Elena Chevez with her medical school cohort in El Salvador. During her career, Dr. Ana has made an immense contribution to polio eradication and broader public health. Credit: Provided by Dr. Ana Elena Chevez

Little Ana first learned about the importance of vaccines from her father, a pediatrician. Growing up during El Salvador’s 12-year civil war meant that electricity cuts were a common occurrence. Whenever the electricity went out, Ana’s father would rush the vaccines he kept in his clinic to the nearby hospital, where generators kept the cold chain refrigerators working. Seeing her father’s dedication to his work, Ana knew she would also become a doctor.

Fast-forward to 2020. Dr. Ana Elena Chevez has dedicated over twenty years of her life to protecting children from vaccine preventable diseases. She has worked in four countries across two regions, and currently serves as a Regional Immunization Advisor for polio at the Pan American Health Organization (PAHO), the Regional Office for the Americas of the World Health Organization, supporting the 52 countries and territories of the Americas to maintain polio-free status.

Throughout her career, she has never stopped dreaming high – advice given to her by family, mentors and colleagues.

Dr. Ana’s first job in public health was as a national immunization manager in El Salvador. Her mentor was PAHO/WHO immunization advisor Dr. Salvador Garcia. “Dr. Garcia taught me everything I needed to know about running an immunization programme. I knew that I could call him at any time, and I would get the answer that I needed,” she said.

The last mile of polio eradication in Nigeria

As polio cases surged in the African region in 2007, Dr. Ana was selected to go to Nigeria to support outbreak response. In a twist of fate, a three-month assignment turned into four years as Nigeria’s Supplementary Immunization Activity (SIA) coordinator.

It was in Nigeria that Dr. Ana refined her skills as a polio eradicator, as well as finding a ‘home away from home’. Credit: Dr. Ana Elena Chevez

This experience was pivotal for Dr. Ana’s career – it solidified her passion for polio eradication and introduced her to new colleagues and a new

country, which would soon become Dr. Ana’s second family and her home-away-from-home.

Dr. Ana was inspired by the constant innovation she saw in Nigeria. “We were always looking for ways to improve quality of the campaigns – improve training, surveillance, cold chain. It was always innovation, innovation, innovation.”

Dr. Ana believes that way of thinking really took Nigeria to the next level. “We started seeing fewer cases, more children vaccinated, and a higher level of acceptance among parents and leaders.”

As SIA coordinator, Dr. Ana oversaw all polio campaigns in the country. During these years, polio campaigns were happening on an almost monthly basis, alongside campaigns for yellow fever, tetanus elimination, and measles. It was overwhelming. “By the time we returned from the field to analyze one campaign, it was already time to start preparation for the next one. It was tiring for everyone – for us (the WHO staff), the partners, for the national/state/local health authorities, and of course for the vaccinators.”

Despite the pressure, Dr. Ana said, “If you were to ask me if I would do it again, I would say yes in a heartbeat. For me, it was being a part of an important moment in history – for the country, for public health, and for the polio programme.”

Maintaining momentum in a region certified free of polio for over 25 years

In 2017, Dr. Ana became PAHO/WHO’s Regional Advisor in charge of polio. The last case of wild poliovirus in the Americas was in 1991 and the region was certified free of polio in 1994. Although more than 25 years have passed since the Americas received polio free status, until polio is eradicated everywhere, the disease is still a risk.

25 years since the Americas were certified polio-free, Dr. Ana emphasizes that the region remains at risk until polio is eradicated everywhere. Credit: Dr. Ana Elena Chevez

Dr. Ana explains, “Even though new generations of nurses, doctors, and epidemiologists have not seen a case of polio firsthand, they understand the risk remains.” There have been 26 meetings of PAHO’s Technical Advisory Group (TAG) meeting on vaccine preventable diseases, and polio has been included on the agenda for every meeting.

It has not always been easy to keep this momentum. In recent years, countries in the Americas have had trouble meeting the indicators required to prove sensitive surveillance systems. For the last few years, PAHO has been holding almost yearly regional polio meetings to sensitize countries on the GPEI’s requirements for eradication and stress the importance of achieving high immunization coverage rates for polio and high standards of surveillance.

Dr. David Salisbury, chair of the Global Certification Commission for Polio Eradication, said at the regional PAHO polio meeting in 2017 that “there will be no free pass” for countries that are polio-free. All nations must provide documentation of certification standard surveillance to back up their belief that polio is eliminated amongst their population.

For Dr. Ana, these words hit home, “The work done by those that here before me has helped the countries to be aware. It has been my role to keep that momentum alive and help countries meet the required goals established in the Endgame Strategy.”

A message for the new generation of women public health leaders

In recent decades, women leaders in public health and immunization made important contributions to a field once dominated by men.

Dr. Ana recalls many of the women leaders that she’s worked with and considers that they have gone above and beyond what is expected. “They have raised the bar and have given the message that other women can work in public heath – it doesn’t matter your religion or colour – it matters that you care.”

Dr. Ana is excited to see more women step into leadership roles. “The new generation is coming. We need them – we need to prepare them. We are close to polio eradication, but we must think about what is next and prepare the new generation to tackle these issues with confidence. I tell my nieces that they can go and contribute to the world and make an impact.”

Reflecting on her own motivation, Dr. Ana says, “I always believed that I could make an impact, I just needed the tools, time and opportunity.”

“Young women leaders: Keep dreaming high. Keep dreaming that you can influence the health of whole populations. Don’t be afraid to set high goals– don’t be afraid to think that it is possible to control, eliminate, or even eradicate a disease.”

In every corner of the world, women leaders in Rotary are leading the charge to make polio history. They are fundraisers, volunteers, polio survivors and advocates from all backgrounds and walks of life with one thing in common: working to ensure that no child ever has to suffer the devastating and paralyzing effects of polio. Meet five women in Rotary whose work is leading the way in the fight to end this disease.

Judith Diment

Diment, of the Rotary Club of Maidenhead Thames, England, leads Rotary’s UK advocacy efforts, and is a passionate fundraiser and International PolioPlus Committee member.

She recently spearheaded Rotary’s efforts to create polio eradication champions among UK political leaders, resulting in the country committing up to an additional $US514.8 million to the Global Polio Eradication Initiative (GPEI) to fund the 2019-2023 Endgame Strategy.

In 2019, former UK Prime Minister Theresa May and Queen Elizabeth II both publicly recognized Diment for her philanthropy to polio eradication and other causes. Hear more from Diment.

Ijeoma Pearl Okoro

“Until the last child is reached and immunized, no child in the world is free. Let us all support the cause to end polio now.”

Ijeoma Pearl Okoro is a member of the Rotary Club of Port Harcourt, Nigeria where she directs End Polio Now activities throughout sub-Saharan Africa. She leads efforts to build awareness around the fight to eliminate polio from Nigeria and engages other Rotary members and the public through events and promotional endeavors.

Through a range of activities like government advocacy, celebrity engagement and fundraising, Okoro’s leadership helps ensure that polio eradication is a priority and every child is protected from the disease.

In 2019, Nigeria surpassed three years without a case of the wild poliovirus, and the African Region is expected to be certified as wild polio-free in late August 2020.

Tayyaba Gul

A member of the Rotary Club of Islamabad (Metropolitan), Pakistan, Gul runs a Rotary-funded health center in Nowshera, working with teams of female vaccinators help reach neighborhoods of ethnic Afghan refugees displaced by conflict in tribal border regions. Gul’s teams use cellphones for daily data reporting on immunization progress, which helps health teams analyze data and report back in real time.

As one of only two countries that continues to report cases of the wild poliovirus, fighting polio in Pakistan is key in achieving a polio-free world. “I just contribute my part as a Rotarian. I’m happy to work in remote areas, especially with women, motivating them to play their role in society,” Gul says. Watch to learn more about Gul’s work in Pakistan.

Ann Lee Hussey

Ann Lee Hussey has led Rotary volunteers on nearly 30 trips to places like Pakistan and Nigeria to immunize children against polio, the disease that has affected her since she was 17 months old.

A member of the Portland Sunrise Rotary Club, Maine, USA, she is an outspoken advocate for polio eradication and immunization and has testified at state legislative hearings in Maine on the importance of vaccination.

In January 2019, Hussey spoke of her experience as a polio survivor and her Rotary service at Rotary’s International Assembly, highlighting the role of frontline polio workers: “Without question, the many health workers around the world—most of whom are women—are the unsung heroes on the polio front. Without them, we would not be where we are today.”

Marie-Irène Richmond-Ahoua

Richmond-Ahoua joined the Rotary Club of Abidjan-Biétry, Côte d’Ivoire, in 1991, making her one of the first female Rotarians in Africa.

When a general canceled a national immunization day during a 1999 coup in her country, Richmond-Ahoua appealed directly to the general’s family, pleading that innocent children had nothing to do with the war. Shortly afterward, the general granted her request and presided over the opening of the rescheduled immunization day.

Richmond-Ahoua coordinates national polio immunizations and serves on the Africa Regional PolioPlus Committee. She also spoke at Rotary’s 2018 World Bank International Women’s Day event.

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Dr Fiona Braka has spent 17 years working to eradicate polio in the African Region. ©WHO Nigeria

Dr Fiona Braka holds one of the highest-stake roles in the African regional polio programme – supporting the Government of Nigeria in their fight to defeat wild poliovirus.

She is the first woman to hold her position in Nigeria, and before that was the first female polio team lead in Ethiopia.

Fighting the last wild virus in Africa

Dr Braka’s work involves leading the country team to strengthen routine immunization and maintain high quality disease surveillance systems in Nigeria. She is also heavily involved in the COVID-19 response, lending expertise established over decades of fighting polio.

In 2016, the detection of wild virus in Nigeria after nearly two years without cases was a devastating setback. “When the outbreak broke out, I was in Uganda on a break with my family. I was having lunch with a friend and my phone was ringing, persistently ringing – a Geneva number. When I picked up the phone it never crossed my mind it would be a wild virus,” Dr Braka remembers.

“A good proportion of Borno state was inaccessible due to armed conflict. Delivering vaccination services and conducting surveillance in that area had not been easy. With interventions going on to address the conflict by the Nigerian Government, some ground was gained, and people trapped for over three years were able to move out of the liberated areas to internally displaced persons camps. With population movement, a wild polio case was detected in an internally displaced child.”

Cutting short her family holiday, Dr Braka raced to Borno to help launch a truly innovative outbreak response with the government and partners. Adapting strategies for polio response to an insecure setting, the programme started settlement-based microplanning guided by local security assessments, innovative surveillance approaches, and the use of GIS and satellite imagery to estimate trapped populations.

The estimated number of children inaccessible to vaccinators has dropped from over 400,000 in September 2016 to less than 30,000 in May 2020 – an enormous achievement for the programme.

Dr Braka is passionate about equal participation and leadership in public health. ©WHO/Nigeria

Balancing motherhood and a career in public health

The challenges were very different when Dr Braka was working on the 2013 Horn of Africa outbreak in Ethiopia’s Somali region. Cases of polio were occurring among pastoral communities and the programme had to rethink tactics to ensure the children of nomadic populations could be reached with vaccines. To maintain the cold chain, polio teams travelled on donkeys or on foot through the bushes. Community leaders among the nomads were employed to help vaccination teams reach families on the move.

“I recall the advice of a parent of a nomadic child who had contracted polio. He said, “We follow where the clouds and rain go – unless the polio programme also moves with the clouds and the rains as we do, you will never reach us and our children will never get the vaccine”. This became a guiding quote for us,” Dr Braka remembers.

This was also a time of personal challenge, as Dr Braka’s youngest daughter was less than a year old. On one occasion, Dr Braka brought her baby with her to a vital cross-border collaboration meeting in Somali region between the Somalia, Kenya and Ethiopia teams. She recalls, “I had to stay in the same hotel as the meeting so I could run upstairs during the break to breastfeed. That moment really stands out an example of the tough decisions you must make as a parent.”

Dr Braka praises steps taken so far to promote women’s professional development in public health and leadership, whilst noting there is more to do.

“The WHO Regional Director for Africa, Dr Matshidiso Moeti, has provided opportunities for capacity building for women. There has been the first training this year for senior women leaders in the African region – I am proud to be part of this.”

Part of the Global Polio Eradication Initiative Gender Strategy 2019-23 commits to promoting a gender-responsive organizational culture. By placing gender at the heart of operations, the strategy closely aligns with the policies of major donors to polio eradication including Canada, Germany, Australia and the United Kingdom.

Explaining why she is a strong supporter of gender equality at all levels of public health, Dr Braka finds, “Even occupying leadership roles you have to have gender in mind – you have to be prepared to prove yourself a bit more.”

“It remains our responsibility to create a policy environment that gives opportunities for men and women.”

Dr Braka delivering polio vaccine to children in Borno State during an outbreak response campaign. ©WHO/Nigeria

A duty to end polio

Dr Braka emphasizes that many people forget how damaging the disease is.

“Whilst we have polio anywhere in the world, we are all at risk of cross-border virus spread. Until polio is eradiated globally, we must be on our toes with robust surveillance systems and infrastructure to deliver vaccines.”

Dr Braka has been able to sustain her demanding job in part thanks to the support of her family. She explains, “I have a very supportive spouse…He knows the polio programme as well as I do!”

“My late father was also very supportive of my career. My mother has been more than a mother – a strong pillar of support, mothering her grandchildren when I am not there and providing moral support in the background.”

She explains that she can’t imagine a next generation suffering from polio when a vaccine is available.

“Vaccines are a powerful tool and the evidence is clear for saving lives. They reduce burden on families, economically, emotionally, and they prevent the suffering of children.”

“We have a duty to secure children’s future to be healthy citizens.”

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Melissa Corkum with women polio workers of the Immunization Communication Network in Afghanistan. ©Melissa Corkum

In 2003, Melissa Corkum received a call that would change her life. The World Health Organization wanted to interview her for a position in their polio eradication team. Like most people who are hearing about polio eradication for the first time, the story compelled her, and she packed her bags to embark on a new adventure. Seventeen years later, she remains a dedicated champion of polio eradication.

A self-proclaimed ‘virus chaser’, Melissa has worked in all three polio endemic countries – Afghanistan, Pakistan and Nigeria. She found inspiration in her first field job in Nigeria, where she realized the scale of the polio eradication programme and that she was a part of something tremendous in public health history.

“I was amazed and inspired when I first saw the efforts of the front-line workers delivering vaccines to the doorstep. It may seem simple to deliver a couple drops into a child’s mouth, but when you see it in motion for the first time, it is truly remarkable,” Melissa said.

To this day, Melissa remains in awe of the work required to make ‘reaching every child’ possible. From mobilizing financial resources, to getting vaccines where they need to be while keeping them cool. From the microplanning to ensure all children and their houses are on a map, to the mobilization of champions in support of polio and immunization. Along the way, the stewards of these processes play an essential role to deliver the polio vaccine.

Melissa has worn many hats during her time in polio eradication, but her current role may be the most challenging yet. As the Polio Outbreak Response Senior Manager with UNICEF, she must answer the formidable challenge of containing outbreaks, using her expertise to inform global policy, strategy and operations.

To do this Melissa spent 80% of her time in the field prior to the outbreak of COVID-19, working with partners of the Global Polio Eradication Initiative (GPEI), Ministries of Health and local health workers.

Her work is a mix of challenge and excitement – the challenges of containing outbreaks, including those affected by the COVID-19 emergency – and excitement in developing new tools and methods to overcome the evolving challenges that present barriers to eradicating polio.

“There is never a dull day no matter what hat you may be wearing within this programme. If we are going to put an end to polio for good, we are going to have to fight the fight on a number of fronts – endemics and now the emerging issue of outbreaks in a post-COVID world,” said Melissa.

“The key is a willingness to do whatever it takes to get the job done.”

At times, Melissa felt the weight of the enormous challenges to eradicate polio, especially during her time in Afghanistan, where protracted conflict has complicated efforts to deliver basic services to the most vulnerable. Melissa often reflects on her time as Polio Team Lead there and the emotional rollercoaster she faced trying to stay ahead of the virus, while watching the tragedy of war unfold in the country.

“But when I felt down, I would pick myself up and get ready to face the next challenge. I found hope and inspiration in the resilience of the Afghan people, especially the women who worked in the polio programme, risking their lives and demonstrating a courage that stood out amidst all the difficulties.”

“It is so inspiring to be part of something tangible and something that is completely possible if we commit ourselves to doing everything possible to find every last child”. ©Melissa Corkum

Melissa sees gender as one of the keys to polio eradication. She firmly believes that the only way to tighten the gaps in the system is by involving and empowering women equally in all roles across the programme, and that the only way to reach every child is to ensure their caregivers are equally informed and engaged in the decision making process.

“Unless we involve more women in the programme in certain corners of the world, we will continue to reach the same children and miss the same children, making polio eradication ever more difficult,” Melissa said.

“Change won’t happen if we don’t change the way we think about involving women. We need to listen to their views and open the doors for more women to join and participate equally from the community level and all the way to the leadership, decision-making level.”

Melissa was born in a small town in Nova Scotia, Canada. Her views on the critical involvement of women and gender equality in the polio programme very much align with her government’s Feminist Aid Policy. The Government of Canada has been a long-time champion of polio eradication and recently generously pledged C$ 190 million to assist the GPEI achieve its objectives of polio eradication.

Greater gender equity is one of the legacies that the polio programme is working to leave behind after eradication. Reflecting on her career, Melissa explains what keeps her working to defeat polio after all these years.

“It is so inspiring to be part of something tangible and something that is completely possible if we commit ourselves to doing everything possible to find every last child”.

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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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A female vaccinator stains the finger of a child who has just received a polio vaccine. This photo is illustrative and does not feature the women interviewed for this story. ©WHO

Noora Awakar Mohammad

Noora Awakar Mohammad was only sixteen years old when she started working as a volunteer for the Polio Programme in Somalia. Since then, she has lived through civil war and armed conflict in her country, which have left the health infrastructure in tatters. Recalling the days of war, Noora’s face tenses. “During the civil war years, on many occasions the polio campaign was stopped because of intense fighting. As soon as the fighting would stop, we would run to communities to vaccinate children,” she recalls.

During those days, it was mostly elderly women and mothers who trained as vaccinators. The adolescent Noora had to work hard to build community trust. “Often, I stayed with the community and vaccinated the children amidst war. The community trusted me even though I was a young health worker,” she remembers.

Noora still faces challenges in her fight against polio. Many areas in Somalia are unreachable because of the presence of non-state groups. These groups, who oppose vaccination, have been responsible for creating fear among parents by spreading misinformation. Noora has also encountered vaccine-hesitancy among parents because of inadequate health awareness. “I have seen fathers refusing to vaccinate their children on one hand, while mothers request us to vaccinate them on the other. Under such trying circumstances, we have to seek the help of religious leaders to convince the refusing fathers,” Noora explains.

Alongside polio vaccination, Noora works as a midwife. As part of her role, she educates pregnant women and young mothers about the benefits of vaccination. She also builds awareness of Acute Flaccid Paralysis (AFP) in the community, a key symptom of polio. “I share information about AFP with mothers and now I see more and more mothers bringing their children to health centers even with the slightest symptom of AFP,” Noora says.

Noora emphasizes that closing the current polio outbreak in her country remains tough given the climate of insecurity and inaccessibility, but she remains determined to carry on with her work.

A female health worker monitors the polio vaccination campaign coverage. This photo is illustrative and does not feature the women interviewed for this story. ©WHO

Zainab Abdi Usman

Zainab Abdi Usman is a midwife in Madina district in Banadir state in central Somalia. For the last twenty years, she has volunteered for the polio eradication programme. A source of frustration for Zainab is the children missing out on vaccination in inaccessible areas. The barriers health workers face to access populations in desperate need of basic healthcare and community services are sometimes insurmountable.

“During the civil war, I used to carry the vaccine in a thermos kettle to keep it cold and I would hide it under my Abaya. If fighters got suspicious, they would not allow me to go into the communities to vaccinate the children. Today, many areas remain inaccessible,” Zainab says.

Whenever the access situation changes, the polio programme is amongst the first health initiatives to reach children. Zainab explains, “In a conflict situation, there is an immediate need to treat victims of the conflict. However, at the same time, it is important that we save our children from paralysis resulting from polio. Therefore, reaching out to children in insecure areas is very crucial in our fight against the disease.”

Women check their vaccine supplies during a polio vaccination campaign. This photo is illustrative and does not feature the women interviewed for this story. ©WHO

Feriha Abdur Rehman Yusuf

Feriha Abdur Rehman Yusuf is the young mother of a one-year old boy. She sees the fight against polio as personal and has been part of over 30 immunization campaigns in Somalia.

An incident from Feriha’s past stays with her years later. “One day, during a door-to-door campaign, I knocked at the door of a house. A man carrying a gun opened it. He yelled at me and started shooting in the air. I was shaken for days,” she remembers. Thankfully, the situation has changed in Feriha’s district since then.

Thanks to efforts to educate parents, the public is more aware of the long-term benefits of vaccination. However, Feriha still faces a few families who reject the polio vaccine during campaigns. She tries to convince parents using the examples of her own son, and her nephews and nieces. If families continue to be worried, she seeks help from religious leaders and community members.

Working during campaigns is not easy for Feriha now she has her son. Feriha says that her mother is the biggest supporter of her work and source of encouragement. “When I am in the field during the polio campaigns, my mother practically moves into my house and takes care of my child,” she says.

Feriha believes that despite the climate of insecurity and inaccessibility, things are improving in Somalia. “Health services are getting better than before. More and more children are getting vaccinated, so they have a better shot at life,” she says.

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Thousands of women work in the Pakistan polio eradication programme as scientists of many specialties, managers, data experts, vaccinators, front-line team supervisors and social mobilizers. We asked a few of them about gender equality in their work.

Dr. Maryam Mallick supports equality everywhere. ©WHO Pakistan/Sadaf Kashif

Dr. Maryam Mallick: The Medical Rehabilitation Specialist

“Women face extra difficulties in trying to prove themselves and often compete in an outnumbered male dominated work environment. But with the right support, they persevere and excel in their tasks.”

Dr. Maryam Mallick is one of the first female technical advisors for disability and rehabilitation at the World Health Organization in Pakistan. Her job involves assessing children with polio paralysis to ensure that they receive medical and social rehabilitation care.

Dr. Mallick works to ensure that all children, especially girls, are given access to quality healthcare as well as equal opportunities in society.

“There were many instances where parents did not want their polio affected daughters to be sent to the schools. We need to start perceiving gender equality as a fundamental human right inherently linked to sustainable development, rather than just a women’s issue,” she says.

“Women’s empowerment in achieving sustainable development has now been globally recognized as the centrality of gender equality. It does not mean that men and women become the same, rather it means that everyone can have equal rights and equal opportunities”

Under Dr. Mallick’s supervision, one thousand children have been assisted by the Polio Rehabilitation Initiative since 2007.

Dr. Iman Gohar: The first female Provincial Rapid Response Unit Lead in Sindh province

Dr. Iman Gohar strikes the #EachforEqual pose, used to promote gender equality. ©WHO Pakistan/Dawood Batozi

“Many women in the programme have enormous talent and endless potential. These women are key to enabling success across the polio eradication effort.”

Dr. Iman Gohar joined the Pakistan polio eradication programme six years ago, working as a Polio Eradication Officer in Peshawar and then as the Divisional Surveillance Officer in Hyderabad. Today, Dr. Gohar is the first woman to lead the Provincial Rapid Response Unit in Sindh.

Dr. Gohar’s work involves leading investigations into suspected polio cases and organising case response campaigns. An increased number of environmental samples found positive for the poliovirus in Sindh in the 2019-2020 period has meant a busy workload.

“Polio eradication is an incredibly demanding job. I work for long hours and enjoy one day off in the week. While performing my job, I work hard to take complex goals and convert them into high quality deliverables,” she says.

“The programme has provided women with a very conducive environment to grow, learn and voice their opinion. For this, I am very grateful.”

When talking about how the programme can improve gender equality, Dr. Gohar stressed the role and support of her male colleagues.

“I believe for us to achieve true gender equality, it is essential that our male co-workers become advocates for equality. Men and women must both hold each other up, celebrate each other’s successes and recognize that each and every person, regardless of gender, is playing an important role in safeguarding the health of Pakistan’s children.”

Making the sign for #EachforEqual. ©WHO Pakistan/Saima Gull

Salma Bibi: A Health Worker in Killa Abdulla district, Balochistan province

“Nothing gives me greater satisfaction than knowing how I have helped people through my duties. I believe that creating opportunities for women is one of the best ways to empower them.”

Salma has been a community health worker for over a decade, working in Killa Abdullah district in Balochistan province. Around 90% of the district is overseen by male health workers, so Salma is one of the few women who go door to door to ensure that children are vaccinated.

Salma often feels greater resistance from community members than her male counterparts. “I hear a lot of negative comments from community members, especially when covering vaccine hesitant families. These words can sometimes de-motivate and de-moralize us from our duties,” she says.

Despite this challenging environment, Salma recognizes that her role is integral to get parents to understand the importance of vaccination.

“When our male colleagues cannot enter the homes, we play an important role in filling that gap. We go in and we sit with the mothers to help them understand that vaccinating against polio is the only way to protect their children. Often, the time spent talking to them is enough, and this makes us feel good, like we are truly helping our nation’s children.”

Saba Irshad: The first female Programme Data Assistant in Multan district, Punjab province

Committed to gender equality. ©WHO Pakistan/Saima Gull

“The greatest challenge that the majority of the professional women face is the perception that they are not as qualified or competent as their male colleagues, irrespective of their experience, education, potential or achievements. Because of this, women often have to work twice as hard.”

Saba Irshad has worked with the Pakistan polio eradication programme for eight years. She is known by her colleagues for her quick problem-solving skills and meticulous work. As a Programme Data Assistant, Saba is responsible for collecting and analyzing data from campaigns implemented in Multan district, in Punjab province.

Saba emphasizes the need for the polio programme to continue to support and encourage their female workforce, and promote an inclusive work environment.

“On average, 62% of the vaccinator workforce in Pakistan are women. This shows just how important women are to polio eradication.”

“Without these women, the programme would be unable to reach thousands of children with the vaccine.”

To learn what the Global Polio Eradication Initiative is doing to promote gender equality, visit the gender section of our website.

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Dr. Faten has spent almost 25 years fighting the poliovirus. ©Faten Kamel

Dr Faten Kamel is on a flying visit to the WHO Eastern Mediterranean Regional Hub, stopping for meetings and to deliver a lecture on the relationship between polio and patients with primary immunodeficiencies. Then she’s off again – to Pakistan to take part in a polio programme management review.

Dr. Faten has travelled to every country in the Eastern Mediterranean Region, and many more besides. Alongside working as a Senior Global Expert for the programme, she is a wife, a mother, grandmother, and an informal mentor to women in public health.

Growing up in Alexandria, Egypt, Dr. Faten was exposed to the life-altering effects of polio on the people around her and was inspired by the work of her father, a surgeon and a Rotarian.

“My father was my role model, he had great passion for helping others and was also a Rotary Club president in 1989. His project for that year was on polio eradication.”

“Polio was prevalent in Egypt in those days. A number of people around me were affected. I was touched by their suffering in a place which was not highly equipped for people with special needs at that time.”

Checking the immunization status of children in Upper Egypt. ©Faten Kamel

Making rapid gains against polio

After graduating from her Medical Degree and Doctorate in Public Health, and lecturing for several years at Alexandria University, Dr. Faten moved into a role for WHO. She found her niche working in the immunization team. “Immunization is the most cost effective public health tool – it can prevent severe and deadly diseases with just two drops or a simple injection – I strongly believe in preventive medicine,” she explains.

“I became the Eastern Mediterranean Regional Medical Officer for polio eradication in 1998. At that time many countries were still endemic.”

The 1990s and early 2000s were years of rapid gains against the virus. However to fully eradicate polio, it was becoming clear that the programme would have to be more ingenious than any disease elimination or eradication project that had come before.

Dr. Faten took a leading role. She explains, “Strategies for immunization and disease surveillance were established, and these methods evolved over time. We pushed the boundaries to make the programme more effective – shifting to house to house vaccination, detailed microplanning and mapping, retrieval of missed children and independent monitoring.”

“We started as a small team – covering different aspects of work and supporting all the countries. My team started the regular analysis and publishing of data in “Poliofax”, we supported the shift to case based and active surveillance and gradually added different supplementary activities including environmental surveillance.”

“I was blessed to have the support of my parents, my husband and my son. As a married woman I think it is very important to have the support of your family. I also had wonderful supervisors who believed in my capabilities and gave me opportunities. I am similarly impressed with many of the young women in the programme today.”

Determined to monitor immunization activities in hard to reach areas in Pakistan. ©Faten Kamel

Overcoming outbreaks

Sometimes the biggest challenges for Dr. Faten and her team came out of the blue, such as when the programme faced huge polio outbreaks in areas that had become free of the virus.

“We didn’t expect polio to cause large outbreaks, but we were faced with them. To overcome the situation we started to work together as partners on effective response strategies within and across regions. The virus does not stop at borders and we had to coordinate multi-country activities.”

“In the polio eradication programme we cannot be satisfied with 80% or 90% coverage – we need to reach each and every child no matter where they are, even in the hard to reach and insecure places. So there was always a lot of innovation and adaptive strategies, we were thinking how can we bridge this, and reach these children.”

“That’s how we came up with access analysis and negotiation, days of tranquility, using windows of opportunities and short interval campaigns, community involvement and collaboration with NGOs, intensifying work at exit points, thinking out of the box all the time.”

Visiting homes in a tribal area of Pakistan close to the border with Afghanistan. All children in this photo lived in the same household, underlining the importance of going door to door to ensure that every child is reached. ©Faten Kamel

Tracking polio down unexpected paths

Dr. Faten was determined to possess firsthand information on polio cases, no matter where they occurred. Sometimes, this led her down unexpected paths – such as when she travelled 21 hours through the Sudanese bush to track down a polio case in a remote village.

“I’ll never forget when a wild poliovirus type 3 (WPV3) case appeared in a very faraway place in Sudan after years without WPV3. I said, “I have to see it myself”. This mission was one of my most challenging fieldtrips.”

“We faced many difficulties, it was the rainy season, the car slipped on its side on our way and we arrived after midnight.”

“I thought the virus must have been hiding in this place for years. But I found the disease surveillance to be very good. Then by investigating, we found there was a wedding, and relatives were coming from another province, so I could nearly point my finger to where the virus came from. The virus was detected in that area and we managed to curtail its spread.

Addressing the media to declare the end of the Middle East polio outbreak on World Polio Day, 24 October 2015 in Lebanon. ©Faten Kamel

A career spent getting ahead of the virus

In 2016, Dr. Faten set up the Rapid Response Unit in Pakistan – a dedicated ‘A team’ that can jump into an at-risk area to mitigate virus spread. Today, she is working with medical professionals to ensure that individuals with primary immunodeficiencies get tested for poliovirus, as some of them are at risk of prolonged virus shedding.

What keeps her awake at night?

“I care about where we are not reaching. Polio eradication is beyond health – it needs all the sectors to come together especially in a big country. In the last strongholds of the virus we have population movement across the border, some areas that are difficult to reach, and there are some misconceptions.”

“If someone comes and says this area is inaccessible, this is not an answer for me. I ask: What should we do to reach? I like to make use of the ideas and experience that come from local people. The virus strongholds are in certain areas, so let us work closely with the people in these areas, empower them, and allow them to change the situation.”

Dr Faten is proud to be part of the polio eradication programme and looks forward to the day when polio eradication is achieved, so she can spend more time with her family in Australia.

“As a grandmother, I am especially determined to finish the job. I want my grandkids to grow up in a world free of polio. This will be my contribution to their futures.”

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Masooda manages a team of 56 community outreach workers. ©UNICEF/Afghanistan

Amidst the extreme heat of the Afghan summer, Masooda, a polio outreach worker, moves with confidence between houses. Her aim is to talk to families that refuse to vaccinate their children against polio. Her energy is endless and she tops that with a smile and a warm way of talking with women and men.

Masooda has an impressive range of skills. She works as a skilled midwife with passion for her community. She is also a District Communications Officer for the polio programme, leading a team of 56 community outreach workers in her neighbourhood.

“I want to help my people – polio is a danger to every child, and we should eradicate it”, says Masooda.

Masooda recalls her early days with the programme, “I faced tough refusal families who denied their children the polio vaccine. A woman refused to vaccinate her younger sister. After one year, the sister died of measles as she hadn’t been vaccinated against it. Now, the same woman has a baby girl and she frequently takes her baby to the health centre for vaccination. Sadly, she learnt her lesson the hard way”.

Masooda leaves her house at 6:30am during immunization campaigns, just as the sun rises. She checks the outreach plans with her teams before they disperse around the town. Through the day, she makes supervisory visits to her teams and obtains updates on vaccine uptake issues. When she receives reports on absent and missing children, she converses with families in order to encourage them to vaccinate their children.

To eradicate polio from Afghanistan, Masooda thinks there is a lot more to do. She says, “I will continue to work hard, for every child to be able to walk, attend school and grow healthy. It is the whole community cause for generations to come.”

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WHO medical officer Dr Aisha Alhassan conducts an acute flaccid paralysis examination in Jere Local Government Area, Borno State. ©WHO/Nigeria

In Jere Local Government Area, in Borno State, Nigeria, a team of male surveillance officers have been dispatched to look for the poliovirus.

They make a first stop at the home of Hajiya Liman Bello, a mother of three and a housewife.

“Who are all of you and what do you want?” Hajiya asks.

“We are health workers please. We need to collect stool samples from your children as there has been a case of Acute Flaccid Paralysis (AFP) in this area”, they reply.

Hajiya isn’t comfortable with the idea of a male health worker handling stool sample collection for her children. She requests that surveillance officers return with a female colleague if they wish to go ahead.

Recognising the links between gender and disease surveillance

In line with the Global Polio Eradication Initiative’s gender strategy, Nigeria’s polio programme has been quantifying the gender aspect of its work. While women make up 95% of frontline workers delivering polio vaccines, a 2017 study conducted by the World Health Organization found there were significantly more men than women engaged in polio surveillance activities in Nigeria.

In 2016 there were 29 men employed in Nigeria as state epidemiologists compared with just eight women doing the same job; 23 male state disease surveillance and notification officers (DSNOs) compared with 14 women, and at a Local Government level, 609 male DSNOs versus 218 female.

The results of the study prompted reflection by programme staff. Gender, like other factors such as age, education and socioeconomic status, is an important determinant of health-seeking behaviour and outcomes. In the case of disease surveillance officers, gender diversity amongst personnel helps the programme build trust and acceptance amongst parents.

“I believe gender strongly influences disease surveillance and access to immunization services,” says Dr Kabir Yusuof, a health worker who has worked with the Nigerian Government polio programme for over ten years.

Dr Alhassan explains the key signs of acute flaccid paralysis to a pharmacist in Borno State. ©WHO/Nigeria

“Nigeria is generally a culturally attuned country. There are some communities where men only feel comfortable with female health workers, especially when it comes to house-to-house outreach and matters of maternal health. For this reason, I believe the role of women in both polio surveillance and response cannot be overlooked.”

Surprisingly, the report showed there were more men than women working as surveillance focal points in health facilities in northern zones of Nigeria, compared to the south. Using gender-disaggregated data helped the programme see where things need to change.

“WHO advocates for breaking…illusions that women cannot ‘fit in’ when it comes to disease surveillance practice,” says Dr Fiona Braka, Team Lead for the Expanded Programme on Immunization at WHO Nigeria.

Polio eradication was the first disease programme at the World Health Organization to develop a dedicated gender strategy. The Nigeria AFP surveillance gender study had never been done before and has helped lay the groundwork for further examination of the programme through a gender lens. The authors of the study found that the number of AFP cases detected in boys and girls was similar, as were polio vaccination rates.

Dr Braka observes, “Integrating or mainstreaming gender into all facets of socio-economic life is key to tackling gender inequalities.”

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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.

Compared to the busy streets of Hargeisa, Somaliland, just 20 kilometres outside of the city are broad stretches of barren land—home to the nomads. Nomadism is part of Somalia’s culture, and there are thousands of families throughout the country who lead pastoral lifestyles, raising livestock and moving their animals and families as the seasons change. Their frequent movement means that children are not always nearby a health clinic to receive their scheduled vaccinations on time. Such disruption or delay in receiving vaccines can result in low or no protection against common childhood infections.

If children are not immunized against polio, they risk contracting the virus and developing paralysis. They also risk passing polioviruses to other under-immunized children. But the polio eradication teams are committed to reach every last child with polio vaccine notwithstanding challenging terrains.

Look through the lives of polio vaccinators in Somaliland on the third day of the vaccination campaign activities as part of the larger efforts to reach over 1.1 million children with the oral polio vaccine.

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(L-R): Jan Sayyed, Ali Raza and Muhammad Bilal Wasi Jan sifting through thousands of forms from across the country. © Mobeen Ansari

As the sun sets across Sindh province, exhausted polio eradication volunteers head home after a busy vaccination campaign. Each has personally vaccinated hundreds of children. In total, it has taken just a week for 9 million children under the age of five to receive two drops of oral polio vaccine, boosting their immunity against the virus.

In the crowded office of Jan Sayyed, Ali Raza and Muhammad Bilal Wasi Jan however, work is only just beginning. They work in the Polio Eradication Data Support Centre, located in Pakistan’s biggest city Karachi. During the campaign, vaccinators fill in paperwork every time they distribute vaccine drops. They record the number of children reached with vaccines, their existing vaccination status, any vaccine refusals and whether the children are local to the area, or visiting.

Across a typical vaccination campaign, this generates data referring to over two million children, recorded on thousands of forms. It is the challenging job of Jan, Ali, and Bilal to label and classify all this data so that it can be uploaded to an online system and analyzed to improve the next campaign.

Data is the lifeblood of the polio programme

Waqar Ahmad, Technical Officer for Data at WHO Pakistan, analyzing data © Sadaf Kashif

Waqar Ahmad, Technical Officer for Data at WHO Pakistan, believes that if immunization and disease surveillance represent the heart of the programme, then data is the lifeblood that helps the programme inch closer to vaccination.

Different kinds of reliable data help the programme make decisions based on evidence. For instance, data that shows a high rate of vaccine refusals in one area allows the programme to investigate the cause further and act to persuade parents of the importance of vaccination.

But creating effective systems for gathering, sorting, and analyzing high-quality data hasn’t been easy. It has required rethinking approaches, overcoming bumps in the road, and thinking beyond the usual parameters of data management.

Pakistan’s polio data journey

Data collection and record keeping in Pakistan’s polio eradication programme began in 1997. Originally, data was collected only in very specific circumstances, such as when cases of Acute Flaccid Paralysis were detected. Such limited data collection meant that broader programme activities could not be analyzed, which increased the chances that vaccination campaigns could be ineffective. Data on other aspects could ensure that logistics were right-sized, and that human resources were deployed where they were most needed.

Data experts poring over the latest numbers on the Integrated Disease Information Management System (IDIMS). © Sadaf Kashif

In November 2015, the programme introduced an online database designed to provide real-time data, named the Integrated Disease Information Management System (IDIMS).

The IDIMS database is used to store pre-, intra- and post-campaign data relating to multiple areas, including vaccination, disease surveillance, human resource planning, logistics planning, and mobile data collection. Data inputted into IDIMS is directly available for viewing and analysis at the provincial, national, and regional level. It can be cross-referenced with other polio eradication databases.

Young Pakistanis like Jan, Ali and Bilal are part of the workforce that keeps the whole system online. Once they have labelled and classified the paper forms, they pass the data onto their colleagues to be digitized and analyzed.

What’s next for polio eradication data management?

Open Data Kit software

In the Data Support Centres, employees are constantly thinking about how to further improve the IDIMS system. Jan, Ali and Bilal note that digitizing the whole data collection and management process would make the system more efficient, as well as environmentally friendly.

Data collection using Open Data Kit (ODK) software offers a way to do this. The data collection process is the same as with paper forms, except information is recorded in a mobile based application. Once vaccinators are in an area with internet, the data is directly uploaded to the ODK server and the IDIMS server. The ODK system has been rolled out in some areas of Pakistan.

Using data to inform decisions— polio eradication is an organized fight against the disease. © Sadaf Kashif.

Gender innovations

Gender-disaggregated data represents a new area of work for the data management teams. Data included in the IDIMS database assists with gender-conscious campaign planning at the provincial level, while a separate system analyses gender-disaggregated information at the country level. Ensuring female vaccinators are recruited for campaigns is crucial, as women can often vaccinate children in places where for cultural reasons, men cannot.

Increasing user-friendly interfaces

As part of efforts to make systems user friendly, one year ago the polio programme launched online data profiles for Union Councils (UCs), the smallest administrative units in Pakistan. These profiles are available on the National Emergency Operation Centre data dashboard and allow polio programme staff to easily extract sizeable amounts of data about the local epidemiological situation within 30 seconds, as well as compare and analyze data for the past six years.

One of the most useful, innovative aspects of the UC profiles is that they collate information on children who were persistently missed during the last six campaign rounds, with information like contact details and the immunization history of the child. Such information assists the programme in follow-up engagement with the child’s parent or caregiver to encourage vaccination.

This requires speedy information sorting and uploading. Jan notes that his team is filing information more efficiently than they used to. This helps to ensure that details are up to date for nearly every town and village.

Over the coming months and years, further innovations will be introduced to improve data efficiency, range and quality.

Campaign by campaign, form by form, data handlers like Jan, Ali, and Bilal are helping to end polio.

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Asma showing women the polio fatwa book during one of the polio training sessions. © S.Gull/WHO Pakistan

In Union Council Kechi Baig, Quetta district, Balochistan province of Pakistan, Asma needs no introduction. When she talks, people listen. First, when she was one of the few female religious scholars at her local madrassa (school), and of late, as a champion for the polio programme.

For Asma, the segue into community health sensitization was quite natural. Her religious vocation as a teacher, also known as an Alima, and her life-long aspiration to help her community, came full circle when she became a religious support person (RSP) for the polio programme.

“I always wanted to become a doctor… but (it just so happened) I joined a madrassa and became an Alima…when I heard that the polio programme is looking for female RSPs, I took the opportunity. Even though I did not become a doctor, I can workwith doctors to serve humanity,” said Asma about her motivations.

As one of three female RSPs out of a team of 118, she has given unique credence to the polio efforts in her community. Kechi Baig accounts for a significant number of refusals to vaccinate. Community health workers are sometimes unable to make headway with refusal families. In such cases, Asma plays an important role as a faith-based counsellor, drawing upon her knowledge and expertise on religious teachings with communication skills and personal friendships within the community. Asma convinces 15-20 ‘hard refusal’ families in each vaccination campaign.

“I visit the households and leave with grandmothers convinced. As a madrassa teacher, I have seen that most females are unaware of religious teachings of Islam and the role of women to improve society. The polio fatwa (Islamic rulings) book proves to be very helpful because it contains authentic fatwas from venerated religious scholars.”

Asma, religious support person, Union Council Kechi Baig, Quetta district, Balochistan province. © S.Gull/WHO Pakistan

Re-appropriating polio through a religious lens

Asma realizes that bringing an attitudinal change through one-off encounters with refusal households is not enough. She saw the need for a long-term counselling relationship. Now, the polio programme team also conducts community engagement sessions with a cross-section of women across the community — from mothers to grandmothers to young students to women training at Asma’s madrassa—to raise awareness about polio.

“It is a great achievement being part of the training sessions about polio and health where I get to talk about the fatwa book. In almost every campaign I work with community health workers and convince 15 to 20 hard refusals for vaccination. It’s a big opportunity to save children from polio,” explained Asma.

Religious support persons, particularly women RSPs like Asma, play a very important role in mediating how people consider their choices for and against polio vaccination through the religious interface. By incorporating educative, spiritual, and medical knowledge, faith-based counselling goes a long way in neutralizing any refusal predispositions within the community.

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A legion of supporters across neighbourhoods, schools, and households are creating a groundswell of support for one of the most successful and cost-effective health interventions in history: vaccination. These are everyday heroes in Pakistan’s fight against polio.

These thousands of brave individuals are championing polio vaccine within their communities to enlist the majority in the pursuit of protecting the minority — reaching the last 5% of missed children in Pakistan.

One of the major factors that determines whether a child will receive vaccinations is the primary caregiver’s receptiveness to immunization. The decision to vaccinate is a complex interplay of various socio-cultural, religious, and political factors. By educating caregivers and answering their questions, these Vaccine Heroes serve as powerful advocates for vaccination, even creating demand where previously there might have been hesitation. This is where everyday people step in to vouch for vaccination as a basic health right.

Here are some nuanced, powerful, and thought-provoking testimonies on their unwavering belief in reaching every last child:

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Watch video with subtitles in: | French | Arabic |

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Thanks to the unbending resolve and resilience of women health professionals as they go door-to-door across villages and mountains administering vaccine in some of the most marginalized or remote communities, women are truly the backbone of the polio programme at the ground-level. We asked a few of these women about their most daunting and heartening moments in polio, and how they worked through them.

Julia Kimutai—Community Strategy Coordinator Nairobi, Kenya

A day in the life of Julia Kimutai as a Sub-County Community Strategy Coordinator in Nairobi, Kenya. ©WHO EMRO

For Julia Kimutai, a 38-year-old community strategy coordinator in Kenya, educating the public about the importance of vaccines is a constant project. As a specialist in dense urban areas with high rise buildings, Julia knocks on a lot of doors and is often greeted with refusals.

“To convince some mothers is not easy,” she says. “It has never been a smooth ride.”

But where some might just see a campaign-time encounter with skeptical parents as a one-off, Julia sees a long-term project.

“Where we have difficulties is where we double down our efforts to build relationships. We even go back when there is no polio campaign to try to talk with parents, emphasize why vaccination is important and try to do a lot of health education,” she says.

As a woman and as a mother, Julia believes she is uniquely qualified as she can relate, understand and convey the importance of polio vaccines to the numerous apprehensive mothers she meets daily.

“I am a good listener, a good communicator and patient. These tools help me daily as Polio Eradicator and a mother.”

Asha Abdi Dini—District Polio Officer, Banadir, Somalia

A district polio officer with over two decades of experience in Banadir, Somalia, for Asha Abdi Dini, refusals are always heartbreaking. “My worst moment was seeing a family who had three girls and a son. They vaccinated their daughters but refused to allow the boy to take the vaccine. The boy got the polio and the girls survived.”

But Asha takes pride in the challenges she has been able to overcome since joining the polio programme.

“My best moment is seeing the same children I once vaccinated all grown up and bring their own children for vaccinations. It gives me immense hope and happiness,” she says.

Women are on the front lines of polio eradication. ©UNICEF Somalia

Bibi Sharifa—Health Communication Support Officer, Islamabad, Pakistan

A continent away, for 39-year-old Islamabad district health communication support officer, Bibi Sharifa, a big part of the job is demonstrating how women can do difficult work and stand firm in the face of adversity.

“People often think that women are incapable, but they really couldn’t be more wrong. The women on our programme are extraordinary – they are strong, gentle, dedicated, humble, passionate, disciplined and fierce at the same time,” she says. “They are driven by the love of their children and their community, and despite the challenges they face, people should realize that women are like grass, not like trees: where trees can be uprooted by floods, grass can face the brunt of flood easily.”

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Hafiza administering polio vaccine to a young child in Islamabad, Pakistan. © WHO Pakistan/S.Kashif

Like many Pakistani women, Hafiza and Sahiqa start their days in the early morning, when other household members are still asleep. They tackle their domestic chores before beginning their official duties – as polio frontline workers.

“I get up by 5:00 am, if I am to prepare properly for a productive day. I need to manage my home chores before I can set out for my official work. I have to prepare breakfast, lunch, lunch boxes for my children and do the dishes. After that I clean the house and then I have to prepare my kids for school. After sending them to school, I leave for the office around 7:30 am,” Sahiqa explained.

Sahiqa (29) is from Quetta in Balochistan province and Hafiza (22) is from Islamabad. In their careers as Pakistan’s cadre of Lady Health Workers, they deliver house-to-house preventative and curative care to underserved communities, in particular women and children in urban and rural slum areas Locally recruited and community-based, these female health workers are also central to progress against polio in Pakistan’s complex environment.

Across Pakistan, thousands of women do the vital work of immunization in an environment that can be harsh, distressing and even dangerous. They balance this work with the demands of their own children and families, and they put their own needs last.

The women’s official workday starts at 8:00 am and is marked by interactions with the community every day. As part of their work, Lady Health Workers educate women about the benefits of exclusive breastfeeding, on better hygiene practices, supporting the advancement of women and children’s health and wellbeing. They knock on every door of their assigned areas to vaccinate children against polio during frequent immunization campaigns.

Sahiqa from Quetta, Balochistan, is one of thousands of female health workers, constituting 56% of frontline workers in Pakistan. © WHO Pakistan/S.Gull

In Pakistan, women currently make up more than 56% of more than 260 000 frontline polio workers. Having women on the frontlines has been a game changer for polio eradication in Pakistan, given the trusted roles they have in communities and the fact that they are more likely to be allowed to take the crucial step across the thresholds of people’s homes and ensure access for all children to vaccines. Female polio frontline workers including vaccinators, campaign coordinators, supervisors and social mobilizers often work in extremely challenging circumstances to ensure children are protected against polio.

“I remember one chronic refusal family. It was such a difficult task to convince the women of the house to vaccinate their children. We engaged in many discussions and I explained to them that if the polio drops were not beneficial, would I give them to my own kids?

After a lot of convincing, I was able to persuade the women. I was so happy to have managed to convert a chronic refusal case and protect the kids in that house against polio,” Sahiqa said.

Despite multiple challenges, especially working in a conservative province like Balochistan, the health workers remain steadfast and intensely committed when it comes to achieving their goals. They have become creative problem solvers who are motivated by every refusal they convert. The challenges act as fuel and have helped them develop the skills they need to navigate the complexities of the job in this cultural context.

“While performing my job, remaining calm and controlling my emotions are the most difficult skills that I have drawn from these challenges. During this job, I learnt a lot how to avoid taking things personally as this helped me focus on the real objective. With the passage of time, I have realized the importance of maintaining firm boundaries in order to facilitate respectful communication with people,” said Hafiza.

There are different reasons why women in Pakistan make the choice to become polio frontline workers. Some have to support their families and some have to earn money for their studies. Many women take this job because it is the best opportunity to move ahead in life. The defining characteristic of most female polio frontline workers is a passion to serve humanity.

“I feel lucky to have my husband beside me, supporting me in every endeavour. He is also a polio worker and he feels that women have better access to the homes in the communities and can relate to the mothers therefore they have a definite advantage in gaining the trust of the homemakers in the community,” Sahiqa said.

The day is over, but their work is not

The women’s official duty ends with the setting sun, but at home domestic responsibilities await. They have to prepare dinner for the family and then help children complete homework. The idea of eight hours of uninterrupted sleep is a dream for them, but they sleep with the knowledge that they are doing important work, and doing it well.

Hafiza and Sahiqa are individual women, but they are also a reflection of every female worker who is part of the fight against polio. The polio eradication programme would not be where it is today without the contributions of hardworking women dedicated to ending polio.

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Women are the true driving force of the polio programme in Somalia. © WHO Somalia

If you ask the women who work in Somalia’s polio programme why they do what they do, most will tell you they do this to help Somali children, to build a stronger future for Somalia, and to support their own families. Somalia is a complex country with many cultural and institutional challenges for women who work outside the home. Perhaps, as a result, there is a sense of solidarity among the women to pull each other up and work together in the fight against polio.

From the senior member of the polio programme to the district-level polio officer (who chooses to remain anonymous for her own security), and for so many women in between, being part of the polio programme is not just a job, but a way to work together and support each other.

Dr Rehab Kambo—International Focal Point and Head of the Polio Programme, The World Health Organization, Garowe, Somalia

Dr Rehab Kambo wears two hats at The World Health Organization (WHO): International Focal Point and Head of the Polio Programme in the satellite office at Garowe, Puntland state of Somalia. After joining the polio programme, Dr Rehab set out to understand the context she was working in and one of the things she learned was about the strength of Somali women.

Dr Rehab Kambo vaccinating a young child in Somalia. © WHO Somalia

“It is easy not to notice that Somali women are stronger than men in their society, until you spend time with them,” she said.

For Dr Rehab, this realization was driven home on an early assignment. She and a colleague were conducting a surveillance review in a region known as Mudug. Dr Rehab had traveled to Galkacyo by road for eight hours during an active clan conflict, which was no easy feat. Movement was challenging, and the women had to travel with armed escorts. But they were determined, Dr Rehab explains, and they were on a mission.

The two visited transit points at the airport and health facilities to meet with Village Polio Volunteers, who serve the polio eradication initiative at the district level. Upon completing the mission, she and her colleague were elated. Dr Rehab looks back on this as one of the most satisfying – albeit stressful – experiences of her life as a polio eradicator.

Since then, Dr Rehab has taken on the challenge of two roles in one of the most operationally demanding regions in the world. For Dr Rehab inspiration comes easily from the women around her.

“In many instances, they are powerful, independent, and are decision-makers in their families,” said Dr Rehab of the Somali women. Even as a relatively privileged, educated woman, Dr Rehab admits there is a lesson in here for her, and for other women like her.

“Women are so strong, honestly. They can adapt to any role for the good of others,” she said.

Mira A—District Polio Officer, Somalia

Life in Somalia has been extraordinarily difficult since war broke out in 1991, and there is no doubt that it has been harder for women than for men. With an average fertility rate of 6.6 per woman, and high death rates in mothers – one out of every 12 women dies due to pregnancy complications – women are in need of timely and quality health services. A lack of education compounds the problem.

“Despite the challenges, women in Somalia have resiliently stood up to the task and engaged in small-scale businesses over the years to earn a living for their families,” said Mira A, a District Polio Officer in Somalia (we are not using her real name for security reasons).

For Mira A and women like her, taking work outside the home is a way to support not just their families, but themselves – and each other.

“Many women have no time to continue their education or look for other jobs, as they are so busy trying to earn money with their existing means,” she said.

When Mira A looks at the women around her, she sees that education is only part of the answer.

“There is a small sector of women who have managed to earn formal education, but even they do not earn money in most cases. They stay at home and look after their homes and children. Even they need to be empowered, even if it is just to help other women.”

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Polio eradication efforts are as much rooted in the social realities as they are in the technological tools. The success of the Global Polio Eradication Initiative comes down to one simple action: the knock on the door, when the child’s caregiver greets the health worker.

Why do caregivers let vaccinators enter their homes? The caregiver’s decision to vaccinate is influenced by many moving parts: social, cultural, economic, and religious. Women health workers and leaders are able to transcend many of these boundaries as they are not only health workers; they are members of that community – someone’s neighbour, friend, aunt, cousin or grandmother.

Polio-endemic, at-risk, and outbreak countries regularly engage women as health officials in immunization activities, constituting about 68% of the frontline workforce. In Nigeria, 99% of frontline workers are women, followed by 56% in Pakistan and 34% in Afghanistan. But their strength in numbers is not the only reason why women are crucial to polio eradication efforts, they are, in fact, behavioural change agents.

Here’s a look at some of the resilient and inspiring women working to eradicate polio in their communities – in their own words:

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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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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.