Exciting research is underway on a novel oral polio vaccine for type 2 polio (nOPV2), which – if further trials are successful – could be a potential new tool to provide the same level of protection against poliovirus as the current oral polio vaccine (OPV), but without the same risk of mutating into vaccine-derived poliovirus in under-immunised populations.
Results from a phase I study to test two nOPV2 candidates were published in The Lancet in early June 2019. The study, led by the University of Antwerp in partnership with a global consortium of researchers and funded by the Bill & Melinda Gates Foundation, was conducted in 2017 at a unique container park named “Poliopolis” at the University of Antwerp. To test the vaccine, 30 individuals volunteered to spend a month living in the container park – complete with private, air-conditioned rooms, a lounge area and foosball table, fitness room, dining area, daily schedules of entertainment, exercise and health check-ups.
The initial findings from this study are promising, showing that the two vaccines tested at Poliopolis are safe and produce the immune response needed to protect individuals against polio. Results from phase II trials are expected in the coming months, which is when the program will learn whether nOPV2 is a tool that can ultimately be deployed for children at risk of poliovirus transmission.
About nOPV
The nOPV2 vaccine candidates were designed by a consortium of scientists from the UK National Institute for Biological Standards and Control (NIBSC), the US Centers for Disease Control and Prevention (CDC) and the University of California, San Francisco (UCSF), and manufactured by Bio Farma – with several other institutions playing key roles in the development process. Current clinical trials testing the vaccine candidates are taking place in Belgium and Panama. If ongoing and future trials are successful, nOPV2 could be kept in stockpiles and used in case of a VDPV2 outbreak in the near future or after eradication. This would make it a potentially vital tool for keeping the world free of all forms of the poliovirus.
OPV, which has been responsible for reducing the number of global polio cases by over 99% since the launch of the Global Polio Eradication Initiative (GPEI) in 1988, remains the best available tool to eradicate wild poliovirus. It is a safe and effective vaccine that will continue being used widely.
This exciting research on nOPV, however, is just one more way in which the GPEI has continued to innovate to overcome hurdles over the past three decades. We look forward to seeing the results of further research that will tell us if we can add this vaccine to our “toolbox” to protect all children from polio.
“We had not seen vaccination teams in our community for a very long time. Sometimes we go for months without vaccinating our children, if we don’t take our children to the mainland to get them vaccinated”, says Mr. Atebakuro Oton George, a fisherman and father of five, residing in Minibie ward of Nigeria’s Bayelsa State.
A largely riverine state, Bayelsa accounts for over 60% of the delta mangrove of the Niger Delta. Many children here continue to miss their chances at life-saving vaccination, as transport is precarious in the tangle of creeks and rivers that crisscross the state. In 2018 a number of innovative strategies such as, immunization boats at sea and community engagement through the traditional hierarchy and sensitization activities, supported by World Health Organization (WHO) through the Government of Bayelsa were introduced to reach a wider net of children.
“Now on weekly basis, health workers brave the seas and visit our communities to vaccinate our children”, an elated Mr. George continues.
Subsistence farming and fishing are the mainstay of the local population’s economy and diet. Health services are provided by primary health care centers located within the island communities.
“The difficulty of accessing healthcare services is due to suboptimal and expensive coastal and waterway transportation from the distant communities to healthcare centers, hence, innovative strategies are being employed to reach the underserved and vulnerable population with vaccination and other health interventions especially during Supplemental Immunization Activities (SIAs)”, says Dr Edmund Egbe, WHO State Coordinator in Bayelsa.
To reach ‘missed’ children, community engagement activities to increase demand for immunization have been initiated to bolster willingness of caregivers to readily access the interventions even when in the middle of the river or the ocean. The successful implementation of the community engagement framework has resulted in high-level acceptance of immunization services in the State. From April 2018 to April 2019, over 169 836 children received vaccination.
Routine immunization coverage has improved remarkably: the first quarter RI Lot Quality Assurance Survey (LQAS)— a quarterly activity organized by the National Emergency Routine Immunization Coordinator Centre (NERICC) to assess routine immunization performance, reasons for non-immunization as well as efforts to improve uptake and utilization of RI in Nigeria—conducted in April 2019 indicate that the State is second best in the country. Previously, the State was ranked amongst others in the country as poor-performing from the last National Immunization Coverage Survey (NICS) conducted in 2016; this led to the inauguration of an emergency response committee in March 2018.
King Diete-Spiff, the Chairman and the ‘Amanayanbo’ of Town-Brass, in his meeting with the State Traditional Rulers Council said, “Sustaining the innovative strategies of vaccinating vulnerable populations will undoubtedly increase immunity against vaccine preventable diseases and reduce the mortality and morbidity rate in difficult to access communities”. He described the polio infrastructure in Bayelsa, supported by WHO and partners, as the bedrock of driving successful healthcare intervention at the grassroots.
Support for polio eradication and routine immunization to Nigeria through WHO is made possible by funding from the Bill & Melinda Gates Foundation, the Department for International Development (DFID – UK), the European Union, Gavi, the Vaccine Alliance, the Government of Germany through KfW Bank, Global Affairs Canada, the United States Agency for International Development (USAID), Rotary International and the World Bank.
2017 REACH Award winners: Dr. Adamu Keana Sallau, Director for Integrated Health Programs in the Imo/Abia States, The Carter Center, Nigeria; Dr. Nabil Aziz Awad Alla, Former National Guinea Worm Disease Eradication Program Coordinator, Ministry of Health, Sudan; Regina Lotubai Lomare Lochilangole, Social Mobilizer, Federal Ministry of Health, South Sudan; Daniel Madit Kuol Madut, Senior Program Officer, Federal Ministry of Health, South Sudan.
This November, the United Arab Emirates will hold the Reaching the Last Mile Forum in Abu Dhabi, where global health leaders will convene to share insights and best practices on how to map out, eliminate and eradicate infectious diseases. On 22 May 2019, the UAE announced that nominations are officially open for the 2019 REACH Awards, which will be presented at the RLM Forum.
The REACH Awards honor frontline health workers and innovators on disease elimination – the true heroes of disease eradication. These awards are a moment to recognize and celebrate the dedicated polio vaccinators who tirelessly overcome difficult terrain and areas of insecurity to reach every last child with lifesaving polio vaccines.
The Reaching the Last Mile Forum will also host The Global Polio Eradication Initiative’s 2019 pledging moment.
Awards established by Crown Prince of Abu Dhabi and adjudicated by prominent global health leaders; recipients to be announced at Reaching the Last Mile Forum in November
Abu Dhabi, 22 May 2019: Today the 2019 REACH (Recognizing Excellence around Champions of Health) Awards opened for nominations to recognize frontline health workers and innovators who have demonstrated extraordinary leadership and commitment to eliminate global diseases. The Awards were established by His Highness Sheikh Mohamed bin Zayed Al Nahyan, Crown Prince of Abu Dhabi, and will be presented at the Reaching the Last Mile Forum in Abu Dhabi in November.
His Excellency Mohamed Mubarak Al Mazrouei, Undersecretary of the Crown Prince Court of Abu Dhabi, commented: “In many communities around the world, especially the most vulnerable and poor, frontline health workers are the only source of health care. Through their efforts, millions of lives are saved and enhanced, strengthening families and societies. With gratitude for the efforts of these committed workers, as well as global health innovators and champions, we announce that nominations are now open for the 2019 REACH Awards.”
The REACH Awards aim to recognize stories of unsung achievement in global health and disease elimination – and raise awareness of the role of the frontline health worker and game-changing innovator within the larger global health community. “Often making heroic sacrifices, frontline health workers are leading the charge to eliminate the world’s most deadly and debilitating diseases,” said Dr. Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization. “Together with scientists, advocates and other innovators, these inspiring individuals are defending everyone’s right to attain the highest standard of health.”
The 2019 REACH Awards will be judged by jury of prominent leaders from across global health disciplines. The panel will include, among others:
Professor Baron Peter Piot, Director of the London School of Hygiene & Tropical Medicine
Her Excellency Ms. Louise Mushikiwabo, Secretary-General of the Organisation internationale de la Francophonie
Rt. Hon. Professor Lord Kakkar PC, Professor of Surgery University College London and Director Thrombosis Research Institute London UK
Doctor Christopher Elias, President of the Global Development Division at the Bill & Melinda Gates Foundation
Doctor Maha Taysir Barakat, Executive Chair-Elect of the Roll Back Malaria Partnership
Ms. Robyn Calder, Executive Director of the ELMA Philanthropies Services
Mr. Ray Chambers, Ambassador to The World Health Organization for Global Strategy
The call for nominations for the 2019 REACH Awards was launched at the World Health Assembly in Geneva. Nominations can be made in three categories at www.reachingthelastmile.com and must be submitted by July 12, 2019. Award recipients will be announced at the Reaching the Last Mile Forum in Abu Dhabi on November 19, a biennial convening where global health leaders share insights and best practice on how to map out, eliminate and eradicate infectious diseases.
The REACH Awards were first established in 2017. Past Awards include the Lifetime Achievement Award to Jimmy Carter, 39th President of the United States and Founder of the Carter Center, for the Carter Center’s role at the forefront of combatting the Guinea worm disease.
The 2019 REACH Awards will recognize individuals working on a wide range of diseases and workers from interdisciplinary teams. Categories include:
The Unsung Hero Award honors an extraordinary individual who has played a transformative, frontline role in the field of disease elimination, but has been under-recognized for their efforts.
The Game Changing Innovator Award recognizes an individual who has developed and implemented a creative technology or practice in support of disease elimination, acknowledging the need to constantly innovate in the field.
The new Rising Champion Award recognizes an individual who is championing a cause related to disease elimination, acknowledging the significant impact that can be made through advocacy – from shifting attitudes around disease and treatment to working with governments to evolve policies.
An individual who has dedicated his or her career to disease elimination will be honored with the Lifetime Achievement Award.
More than one billion people around the world, especially in remote areas, lack access to healthcare due to weak health systems, and limited access to facilities and trained health workers. Frontline health care workers play a critical role in reaching the most remote communities, often the last stronghold for preventable, infectious diseases. But given the on-the-ground nature of their work, these skilled and committed individuals are often overlooked. The World Health Assembly recognized this week the importance of frontline workers through the adoption of resolutions on community health workers and primary health care.
The United Arab Emirates (UAE) leadership’s dedication to disease elimination builds on the commitment of the late Sheikh Zayed Al Nahyan, Founder of the UAE, and has since continued through a series of contributions from His Highness Sheikh Khalifa bin Zayed Al Nahyan, President of the UAE, and His Highness Mohamed bin Zayed, Crown Prince of Abu Dhabi. Since 2011, His Highness Mohamed bin Zayed, Crown Prince of Abu Dhabi has personally committed US $250 million to global efforts to eliminate deadly and debilitating diseases.
Polio eradication was in high-level spotlight this week in the top echelons of global leadership as World Health Organization (WHO) Member States, donors, partners, civil society organizations, health and development actors gathered this week at the 72nd World Health Assembly (WHA) in Geneva, Switzerland.
In his opening address to delegates, WHO Director-General and Chair of the Polio Oversight Board (POB), Dr Tedros Adhanom Ghebreyesus talked about the long-winding journey of polio eradication since its adoption as a landmark resolution at the WHA in 1988 and the hopes of finishing eradication in the near future: “Together with our partners at Rotary, CDC, UNICEF, the Bill & Melinda Gates Foundation and Gavi, the Vaccine Alliance in the Global Polio Eradication Initiative, we have launched a new strategy to address the most difficult remaining areas in Afghanistan and Pakistan. Earlier this year I came across a video of a man called Irfanullah, wading through snow to deliver polio vaccines in Pakistan. With the dedication and commitment of people like him, I have no doubt we will succeed in making polio history.”
Member States expressed overwhelming support of the Polio Endgame Strategy 2019-2023. The new strategy sets the stage for a decisive win against polio through the parallel pursuit of the wild poliovirus and circulating vaccine-derived poliovirus. The Strategic Plan incorporates collaboration with other health interventions, fostering stronger alliances and managerial innovations by working in close coordination with governments in endemic countries. The Member States welcomed the trifecta of Eradication, Integration, and Containment/Certification, which set the foundations of a sustainable polio-free world by anchoring polio activities within the broader immunization system, ensuring an effective transition of eradication knowledge and assets and ensuring that no poliovirus can paralyze children again.
With an eye towards an inclusive and sustainable polio-free future, there was broad consensus that all stakeholders—governments, GPEI partners, private and public donors, policy makers, health, and non-health actors— are in this together. One of the recurring themes was the need to ensure concerted efforts—financial and programmatic— to get over the hump in this last mile over to the finish line.
The general air was that of cautious optimism, as all Member States acknowledged that the path to finishing polio eradication is well within sight, all thanks to the Endgame Plan 2013-2018 which succeeded in certifying South-East Asia (SEARO) as polio-free, brought the African Region closer than ever to eradication of wild poliovirus, possibly eradicated two out of three wild poliovirus strains, set the world on the path of phased Oral Polio Vaccine (OPV) removal, stopped outbreaks in Syria and Horn of Africa, and cornered wild poliovirus circulation to a joint cross-border reservoir between Afghanistan and Pakistan.
The delegates particularly appreciated the strong commitments espoused by Afghanistan and Pakistan for a more systematic collaboration to jointly target the common wild poliovirus reservoir on all fronts with an approach that combines the scientific with the social and anthropological. Pakistan’s representative said, “We remain resolute with the highest level of political commitment… strengthening routine immunization, addressing prevalent malnutrition, and provision of safe water and sanitation are strategies being implemented in tandem. Communication challenges of low-risk perception and concerns around vaccine safety and efficacy are being addressed through a revised communication strategy. We continue to coordinate with Afghanistan programme to share experience in strategies to manage the common epidemiological block. In light of the recent cases, the Government of Pakistan has decided to carry out a comprehensive programme review on an urgent footing. I would like to sincerely thank our partners and donors who are a part of this initiative and helped us get this far. We pledge our complete commitment to reach every last child, so no future generations have to suffer from a crippling disease like polio.”
Rotary International, one of the pioneering partners of the GPEI, maintained that wild poliovirus eradication remains the overriding priority, and to that end, re-affirmed collective commitment of their 1.2 million members around the world: “It is easy to forget the hurdles we have overcome—such as: addressing outbreaks in more than 20 countries in Africa, or how India had 80% burden of the total polio caseload in the world. Our challenge is not feasibility, but determination…global commitment has brought us to the threshold of a polio-free world. Let us act with urgency to end polio forever.”
In his closing remarks, Dr Tedros thanked the Crown Prince of Abu Dhabi and the United Arab Emirates for hosting a pledging moment for the Global Polio Eradication Initiative, “Global progress to end polio would not be possible without partners like the UAE. I would like to thank His Highness Sheikh Mohamed bin Zayed Al Nahyan, Crown Prince of Abu Dhabi, and the UAE – a long-time supporter of the polio programme – for agreeing to host the GPEI pledging event this November at the Reaching the Last Mile Forum, a gathering of leaders from across the global health space.”
The 72nd World Health Assembly, the governing body of the World Health Organization held by in Geneva, Switzerland is the biggest congregation of public health actors. Taking advantage of the critical mass of global leaders, the Global Polio Eradication Initiative hosted an event for polio eradicators, partners and stakeholders on 21 May 2019.
The event, To Succeed by 2023—Reaching Every Last Child, celebrated the GPEI’s new Polio Endgame Strategy 2019-2023. The five-year plan spells out the tactics and tools to wipe out the poliovirus from its last remaining reservoirs, including innovative strategies to vaccinate hard-to-reach children and expanded partnerships with the Expanded Programme on Immunization (EPI) community and health emergencies.
The informal event brought together a cross-section of stakeholders – partners, health actors, non-health actors, supporters, donors, Ministers of Health of endemic countries, WHO Regional Director for the Eastern Mediterranean, and Polio Oversight Board members – alluding to strengthened and systematic collaboration in areas of management, research and financing activities in the last mile.
Dr Zafar Mirza, Pakistan’s Minister of State,Ministry of National Health Services, Regulations and Coordination, took the stage and gave insight into country-level polio eradication efforts and the need for coordinated action with Afghanistan: “20 years ago, 30 000 children were paralyzed by polio in Pakistan. This year, 15 cases have been reported. While we have done a lot, it is clearly not enough. We are resolute in this conviction. We, together with Afghanistan, must make sure we eradicate polio for the sake of our children. Our science is complete, only our efforts are lacking. Along with the polio programme, the donors and the Afghan government, we will get to the finish line.”
Echoing similar sentiments, Dr Ferozuddin Feroz, Minister of Public Health of Afghanistan, said, “I would like to start by expressing thanks to all the partners for their support. As you know, Afghanistan has a very challenging context due to inaccessibility, refusals, gaps in campaign quality, low routine immunization coverage, and extensive cross-border movement. But, Afghanistan has made progress—five out of seven regions continue to maintain immunization activities. We view polio as a neutral issue and have developed a robust National Emergency Action Plan 2019. We appreciate the Polio Endgame Strategy 2019-2023. We believe coordination with Pakistan will help us deliver a polio-free world. We look forward to your continued technical and financial support to achieve the goal of polio eradication.”
Recognizing the long-standing commitment of the United Arab Emirates, a video was played showing the on-ground efforts of the Emirates Polio Campaign, working with communities and families in Pakistan in collaboration with the Global Polio Eradication Initiative and partners, and the Government of Pakistan. Thanks to the Emirates Polio Campaign, 71 million Pakistani children have been reached with 410 million doses of polio vaccine.
Dr Abdullahi Garba, Director for Planning, Research and Statistics, National Primary Healthcare Development Agency spoke on behalf of Professor Isaac F Adewole, Federal Minister of Health of Nigeria. Dr Garba harked back to the past as the GPEI plans for the future: “Nigeria started actively working to eradicate polio in 1988, at a time when we used to have up to a thousand cases every year. With all our innovation and efforts, I am pleased to inform you today that no wild polio case has been detected for the past 33 months. This feat was achieved through continuous efforts between the government, GPEI and partners, having diligent incidence reporting, reaching inaccessible children, and improving the quality of the polio surveillance immunization activities through strong oversight mechanisms in Nigeria. I know I also speak on behalf of all countries across Africa – we will achieve success.”
Rounding off the evening, Dr Tedros Adhanom Ghebreyesus, the World Health Organization Director-General and Chair of the GPEI Polio Oversight Board, took the stage to recount his first visit of the year to the polio endemic countries of Afghanistan and Pakistan, the progress made over decades, and the need to re-commit to the cause of ending polio. “Together with Regional Director Ahmed Al-Mandhari and Chris Elias of the Gates Foundation, we travelled to Pakistan and Afghanistan. We saw first-hand the commitments by both public and civil society leaders, which gave us a lot of confidence. The other thing that gave us confidence was seeing our brave health workers trudging through deep snow. And of course, our partners: Rotary, United Arab Emirates, CDC, UNICEF, the Bill & Melinda Gates Foundation and Gavi. The last 30 years have brought us to the threshold of being polio-free…(which) lay out the roadmap that is the Polio Endgame Strategy 2019-2023. The Ministers of Afghanistan and Pakistan have also assured us that they will continue to work together in their shared corridor to finish polio once and for all.”
In 1988, the World Health Assembly passed a resolution to globally eradicate poliovirus, in what was meant to be “an appropriate gift…from the twentieth to the twenty-first century.”
As the GPEI plans for the future and its final push to ‘finish the job,’ it is clear that political and financial efforts need to ramp up in this increasingly steep last mile. As he concluded, Dr Tedros thanked committed partners like United Arab Emirates: “Global progress to end polio would not be possible without partners like the UAE. I would like to thank His Highness Sheikh Mohamed bin Zayed Al Nahyan, Crown Prince of Abu Dhabi, and the UAE – a long-time supporter of the polio programme – for agreeing to host the GPEI pledging event this November at the Reaching the Last Mile Forum, a gathering of leaders from across the global health space held once every two years…let us join together to end polio.”
Today, the Global Polio Eradication Initiative (GPEI) launched the Polio Endgame Strategy 2019-2023, which will guide the programme and its partners to overcome the final hurdles to eradication and move toward sustaining a polio-free future.
The new plan hones in on addressing today’s most pressing obstacles to end poliovirus transmission imminently, integrate polio programme resources into health and development programmes globally, and certify the world polio-free. In addition to building on the programme’s core strategies to expand access to vaccination and improve surveillance around the world, the 2019-2023 Endgame Strategy offers responsive and innovative solutions tailored to communities’ needs. These include establishing a regional hub in Amman, Jordan to enhance coordinated support to Afghanistan and Pakistan and creating permanent Rapid Response Teams to accelerate the programme’s response to outbreaks.
The programme will also work to improve immunisation coverage and support basic development needs through strengthened collaboration with immunisation partners such as Gavi, the Vaccine Alliance and the humanitarian and emergency response communities.
To reach its goals and achieve eradication, the Endgame Strategy requires a US$4.2 billion budget, of which US$3.27 billion is to be raised by the GPEI. In support of the Strategy and to encourage additional commitments, a pledging event will be hosted this November at the Reaching the Last Mile Forum in Abu Dhabi, a gathering of leaders from across the global health space held once every two years. The pledging event will be hosted by the GPEI, with the support of His Highness Sheikh Mohamed bin Zayed Al Nahyan, Crown Prince of Abu Dhabi, a longtime champion of the polio programme.
The 2019-2023 Endgame Strategy builds on the 2013-2018 Strategic Plan, which brought the world to the brink of polio eradication. Despite this impressive progress, the last steps to eradication have proved to be the most difficult.
Wild poliovirus transmission continues in Afghanistan and Pakistan, and circulating vaccine-derived poliovirus outbreaks are ongoing in several countries across Africa and Asia. To overcome these challenges, the new Strategy must be fully implemented with sufficient resources and commitments from governments, donors, multilateral organisations, and local communities.
1. There were more cases of wild poliovirus in 2018 than in 2017. Should we be discouraged?
No, not at all. We’ve always expected the number of cases to fluctuate somewhat as we get closer to zero. We’ve gone four straight years with fewer than 100 cases per year. That’s an indicator of great progress. With dedication from governments and Rotarians in areas still affected by polio, we’ll get there.
2. Why is it so difficult to eradicate a disease like polio?
Remember that even in the United States, where the polio vaccine was readily available, it still took 20 years to become polio-free. And the areas we are working in now don’t have health systems that are as well-developed as in the United States.
3. What challenges are you seeing now?
We have been working intensely in the endemic countries — Afghanistan, Nigeria, and Pakistan — for a number of years, and some of the citizens in those countries are getting concerned that we are spending money on polio eradication when they have so many other needs. There’s some resistance to keep on receiving immunizations for polio, and polio alone. Our challenge is to find ways to provide other services to the citizens and children, so we still have the parental support we need — to provide the “plus” in PolioPlus.
4. What role does armed conflict play in those areas?
It makes the logistics of immunization far more difficult. The Global Polio Eradication Initiative partnership is not only dealing with governments — we’re dealing with anti-government elements as well. While we’ve worked to gain everyone’s trust and support, we’ve had areas that were inaccessible to immunization teams for months and sometimes years at a time.
5. Do immunization teams know when they miss children? Or are there children they don’t even know about?
I think we have a good handle now on knowing when and where we’re missing children. The challenge is to keep reducing the number we miss. In Nigeria, we have done a lot of work since the discovery of several polio cases in Borno state in 2016. But access, immunity levels and surveillance are much better today than they were in 2016, when we did detect those cases. We are cautiously optimistic.
6. Where are we seeing successes?
We haven’t had any cases of wild poliovirus anywhere in the world in nearly five years except in the three endemic countries. And in Nigeria, it’s been almost three years since we detected any wild poliovirus cases, and those occurred in a small area of the country. But we are not there yet. Complacency is one of our biggest enemies, and we cannot take our foot off the accelerator until success is achieved.
7. What’s the most important thing Rotarians should know?
I’ve been extremely impressed with the dedication and persistence of Rotarians in Afghanistan, Nigeria, and Pakistan. They are working hard to make sure polio is eradicated. It’s pretty amazing what they do in those countries.
Rotarians should continue to be optimistic and to support eradication. We also need Rotarians to bring the need for continued funding to the attention of their government leaders. We can’t lose sight of the goal.
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.
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.
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 19th 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.”
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 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.
In an extraordinary joint statement by the Chairs of the main independent, advisory and oversight committees of the GPEI, the Chairs urge everyone involved in polio eradication to ensure polio will finally be assigned to the history books by 2023. The authors are the chairs of the Strategic Advisory Group of Experts on immunization (SAGE), the Independent Monitoring Board, the Emergency Committee of the International Health Regulations (IHR) Regarding International Spread of Poliovirus and the Global Commission for the Certification of the Eradication of Poliomyelitis (GCC).
The Endgame Plan through 2018 has brought the world to the brink of being polio-free. A new Strategic Plan 2019-2023 aims to build on the lessons learned since 2013.
The joint statement urges everyone involved in the effort to find ways to excel in their roles. If this happens, the statement continues, success will follow. But otherwise, come 2023, the world will find itself exactly where it is today: tantalizingly close. But in an eradication effort, tantalizingly close is not good enough.
The statement therefore issues an impassioned plea to everyone to dedicate themselves to one clear objective: to reach that very last child with polio vaccine. By excelling in our roles. It means stepping up the level of performance even further. It means using the proven tools of eradication and building blocks that have been established in parts of the world that have been free of polio for years.
The Chairs remind us that as a global community, we have stood where we stand today once before, with smallpox. And we achieved the eradication of smallpox. And the world is a much better place without smallpox.
So, let us make the world again a better place. Together. Let us eradicate polio.
For Dr Tedros Adhanom Ghebreyesus, Director-General of WHO, the start to the new year was marked with a four-day visit to Afghanistan and Pakistan from 5-8 January. The visit came at the heels of his new role as the Chair of the Polio Oversight Board (POB) on 1 January, a committee which oversees and guides the Global Polio Eradication Initiative, signalling the Board’s utmost commitment towards eradication of polio for good.
Accompanied by WHO Regional Director for the Eastern Mediterranean Dr Ahmed Al-Mandhari, Dr Tedros’ well-knit, compact visit covered a lot of bases from field visits to high-level meetings with heads of state from both the countries, giving the POB an opportunity to see that while polio may still be in endemic in Afghanistan and Pakistan, but the process to achieve the goal of ending polio is not far from realization.
“We must all give our best on this last mile to eradicate polio once and for all. My wish for 2019 is for zero polio transmission. You have WHO’s full support to help reach every child and stop this virus for good,” Dr Tedros said.
During his first stop in Afghanistan on 5-6 January, Dr Tedros met with His Excellency President Dr Ashraf Ghani, His Excellency Chief Executive Dr Abdullah Abdullah, the Council of Ministers, representatives of key partners and nongovernmental organizations working in the field of public health. He also visited to the WHO-supported Trauma Care Hospital in Kabul.
In Pakistan on 7-8 January, Dr Tedros met with the Prime Mister Imran Khan, Federal Minister for National Health Regulations & Coordination Mr Aamer, Mehmood Kiani, Minister of Foreign Affairs and Federal Minister for Human Rights Dr Shireen Mazari.
Dr Tedros accompanied the President of Pakistan, Arif Alvi, to the launch of the first Pakistan Nursing and Midwifery Summit and the Nursing Now campaign. He also visited a basic health centre in Shah Allah Ditta where WHO signed an agreement with the Government of Pakistan to develop a model health care system for universal health coverage in Islamabad.
In the last mile of the polio eradication journey, Dr Tedros’ visit serves as a reminder that now more than ever we need to have social, political and global will to make polio the second human disease in history to be wiped from earth.
“On the way to global certification” was the theme of this year’s Regional Meeting on Polio, which convened on 6 December 2018 in Guatemala City. Pan American Health Organization (PAHO) urged collective action to not only ensure that there is no re-emergence of polio in the Americas, but also to lend support in the global fight against polio.
The last reported case of polio in the Americas was documented in 1991 and in 1994 the region became the first to be certified free of the disease. But that is not to say there is room for complacency. Echoing the Global Polio Eradication Initiative’s goal of a polio-free world, Cuauhtémoc Ruiz-Matus, Chief of the Comprehensive Family Immunization Unit at the Pan American Health Organization (PAHO) said, “As long as there is even one infected child, children in all countries are at risk of contracting polio,” during the inauguration.
With recent reports emerging that some of the countries in the Americas have vaccination coverage hovering below 95% — the minimum baseline required to prevent circulation — there is a real chance of outbreak through importation of virus or the emergence of circulating vaccine-derived poliovirus.
“We know that there is a risk of reintroduction of polio, which is why Guatemala has committed to adhere to PAHO’s strategic plan so that the Region remains polio-free,” said the Deputy Health Minister of Guatemala, Roberto Molina. The country recorded its last case of polio in 1990.
Reiterating the need for continued efforts, PAHO Representative in Guatemala, Oscar Barreneche, highlighted that “maintaining standards of surveillance, containment and response to outbreaks, and vaccination is key.”
As the world reaches closer to poliovirus eradication, the countries of the Americas will play an instrumental role in sustaining the momentum for the cause and preventing reintroduction of the disease in the continent.
In the wake of a polio outbreak confirmed on June 26 2018, the Government of Papua New Guinea declared polio a national health emergency. It was imperative that all children under the age of five be vaccinated, even those living in the most inaccessible regions of the country.
As part of the outbreak response, a team from Madang Provincial Health Authority, supported by WHO, travelled for over half a day by road and helicopter to reach the Hagahai people who live in the highlands of Madang province in Papua New Guinea, which is one of the most geographically isolated places in the world.
Ever wondered what it is like to be on the forefront of the fight against polio? Watch and learn how the team made their way to the remote mountain top to deliver vaccines.
Barry Rassin, Rotary International President, presenting an award to Theresa May, UK Prime Minister, as received by MP Alastair Burt on her behalf
On 27 November, Barry Rassin, Rotary International President, presented the Polio Eradication Champion Award to UK Prime Minister, Theresa May, for her exemplary leadership role in driving the cause of eradicating polio. In 2017, the UK pledged US$ 130 million to the Global Polio Eradication Initiative (GPEI) for 2017-2019. So far, the country’s total financial contribution is US$ 1.6 billion, the second highest amount from a G7 donor. The UK has also been a strong advocate of the cause.
The Polio Eradication Champion Award was established in 1996 to honour heads of state, leaders of health agencies, and other inspiring individuals who have played an instrumental role in ending polio. Theresa May joins an illustrious list of past award winners including Canadian Prime Minister Justin Trudeau, German Chancellor Angela Merkel, and former UN Secretary-General, Ban Ki-moon.
“Britain’s leadership in making multiyear commitments in support of global polio eradication has been an example for other countries to follow,” said Barry Rassin at the occasion.
Participants of the Africa Regional Commission for the Certification of poliomyelitis eradication (ARCC) in Nairobi, Kenya, from 12-16 November 2018. WHO AFRO/2018
Efforts to end polio across the WHO African Region came under the microscope at a meeting of the Africa Regional Commission for the Certification of poliomyelitis eradication (ARCC) held in Nairobi, Kenya, from 12 – 16 November 2018.
Seven countries (Cameroon, Nigeria, Guinea-Bissau, the Central African Republic, South Sudan Equatorial Guinea and South Africa) made presentations to the ARCC on their efforts to eradicate polio, presenting evidence on their level of confidence that there is no wild polio in their borders, the strength of their surveillance systems, vaccination coverage, containment measures and outbreak preparedness. Kenya, the host country, alongside the Democratic Republic of the Congo and Namibia, presented updated reports on their efforts to maintain their wild poliovirus- free status.
Professor Rose Leke, Chair of the ARCC, speaking to the participants. WHO AFRO/2018
A total of 109 participants including partners of the Global Polio Eradication Initiative, non-governmental organisations and Health Ministries were in attendance to hear the reports.
The ARCC is an independent body appointed in 1998 by the WHO Regional Director for Africa to oversee the certification and containment processes in the region. It is the only body with the power to certify the Africa region free from wild polio. The African Regional Office and the Eastern Mediterranean Regional Office are the two WHO regions globally that remain to be certified free from wild poliovirus.
Professor Rose Leke, Chair of the ARCC, reflected on the importance of this meeting: “The rich, open and in-depth discussions held this week with each of the ten countries will allow these countries to strengthen ongoing efforts to further improve the quality of surveillance and routine immunization including in security compromised and hard to reach areas as well as in special populations such as nomads, refugees and internally displaced persons.”
Recommendations made
The ARCC, made up of 16 health experts, made recommendations to the ten countries. They noted with concern that outbreaks of circulating vaccine-derived poliovirus in the Democratic Republic of Congo, Kenya, Niger, Nigeria and Somalia were symptoms of low population immunity and varied quality vaccination campaigns. These countries were encouraged to conduct a high-quality outbreak response. Neighbouring countries were advised that they should assess the risk of spread or outbreaks within their borders. Low population immunity was identified as a significant concern, given the risk further emergences of vaccine-derived poliovirus strains.
Inaccessibility and insecurity were also flagged as a significant concern, with limits to the number of children who were being reached with polio vaccines and the coverage of surveillance efforts in affected areas. Countries were advised to scale up strategies that have proved in the past to be effective in the face of these challenges and to build relationships with civil society and humanitarian organisations who could provide immunization services.
Recommendations were made across the board to address chronic surveillance gaps, especially related to factors affecting the quality and transportation of stool samples reaching the laboratory for testing. The introduction of innovative technologies was commended, and a call was made for countries to expand their use, especially in inaccessible and hard-to-reach areas. Countries were also encouraged to accelerate their progress towards poliovirus containment.
In addition, all of the presenting countries received specific recommendations to support their efforts towards improving surveillance, immunization and containment in order to achieve a level that would give the ARCC the confidence needed to declare the region to have eradicated polio.
Dr Rudi Eggers, WHO Kenya Country Representative, said: “I commend all the countries on the efforts that have gone into achieving the results presented in their reports. It gives us hope that eradication is achievable in the midst of the unique challenges faced by all countries. We appeal to all the countries to fully implement all ARCC recommendations.”
Polio eradication efforts in Kenya
Dr Jackson Kioko, Director of Medical Services, the Kenyan Ministry of Health, said: “Kenya has worked hard to rid the country of wild poliovirus, and we will continue to do so until Africa and the world are certified polio-free.”
While Nigeria remains the only country in Africa to be endemic for wild poliovirus, responses are underway to stop outbreaks of circulating vaccine-derived poliovirus in the Democratic Republic of the Congo, Kenya, Niger and Somalia.
The circulating vaccine-derived poliovirus in Kenya was found in a sewage sample in Eastleigh, Nairobi, in March 2018, closely related to viruses found in Somalia. The Ministry Health, with the support of WHO, UNICEF and partners, has done several polio vaccination campaigns since then to ensure that every child’s immunity is fully built and no virus can infect them.
The meeting was chaired by Argentine Secretary of Health, Adolfo Rubinstein; items on the agenda included antimicrobial resistance, malnutrition as it related to childhood overweight and obesity, the strengthening of health systems and the responsiveness of health systems to crises and pandemics.
Senior officials from G20 member and guest countries were joined by representatives from the Food and Agriculture Organization (FAO), the Global Fund, the Organization for Economic Co-operation and Development (OECD), the World Bank, the World Health Organization (WHO), the World Organization for Animal Health (OIE) and Unitaid.
The Health Working Group was created in China in 2016 and provides a platform to continue to address global health policies at the G20 level and advance on global policy commitments in the area of public health.
The G20 is made up of 19 countries and the European Union. The 19 countries are Argentina, Australia, Brazil, Canada, China, Germany, France, India, Indonesia, Italy, Japan, Mexico, Russia, Saudi Arabia, South Africa, South Korea, Turkey, the United Kingdom and the United States.
After more than 25 years on the hunt for polio, it’s easier to list the things the World Health Organization’s Chris Maher hasn’t seen than the things he has. He began his career with WHO five years after the global health community vowed to eradicate polio, which was then found in over a hundred countries. Since then, Maher has progressed to spearhead on-the-ground operations for the global polio eradication initiative, a partnership that has seen the disease beaten back by 99%. In a ceremony in May 2018, the Australian Government awarded him the Order of Australia, recognizing his immense contributions to the fight against a disease that has gone from paralyzing more than 350 000 children every year in 1988, to fewer than 22 cases worldwide today.
In 1993, Maher had several years of experience in public health, but none in polio-endemic countries. “I don’t think I’d ever seen an active polio case,” he recalled. Upon joining the WHO immunization team in a region that spanned from Mongolia to the Pacific Islands, polio was suddenly at the top of his agenda.
Maher and his colleagues worked as disease detectives, stalking the wild poliovirus through hard-to-reach communities in south-east Asia. From immunizing small communities on the Pacific Islands to taking on massive campaigns targeting millions of children in China, the complexity made his head spin.
The Philippines was the first country to go polio-free on Maher’s watch, seeing its last case that year.
Tracking unimmunized children through a population maze
It was here that Maher came face to face with polio’s full force of devastation, after a Khmer nurse at a district health clinic invited him home to meet her son. Maher and a colleague followed the woman to a house on stilts in a flooded field, where a quadriplegic teenager lay on a rattan bed.
“I realized very early on, he had polio. It was typical of the kind of polio that had no rehabilitation whatsoever”, Maher said.
Maher recalls being struck by the young man’s intelligence and his interest in the world, despite his isolation. As polio destroyed his body, his mother bestowed constant care.
“While she was working every day, somehow she had managed to look after him, to provide for him. As an example of motherly love I had never seen anything like that in my life.”
By the 2000s, it seemed that the most challenging country to eradicate polio was India. With its vast population and sprawling slums, in Maher’s words, “If technically we couldn’t do it, India would be the place we’d fail.”
Maher recalls Bihar, India as “the most extraordinary place that I ever worked on polio.” Eighty million people live in the state. Widespread illiteracy, a lack of infrastructure and high levels of population movement compounded the complexity of polio eradication there.
Despite the daunting challenges, Maher and his colleagues developed systematic plans to administer vaccine to all children across the country, taking a critical step in a journey to eradication. By the end of 2011, India was polio-free.
The risk of doing something different
At the start of the global push to eradicate polio, those involved in the operation would sometimes encounter skepticism from those who thought it simply couldn’t be done. The scale of the project, the size of activities and the time, energy, effort and cost involved had never been seen before.
Today, wild polio is endemic in three countries: Afghanistan, Pakistan and Nigeria. Immense efforts to battle the virus into extinction in these places are ongoing. Outbreaks of vaccine-derived polio virus (VDPV) add complexity to the end goal. Conflict, low routine immunization and population movement in the most at-risk areas complicate things further. Some of the approaches Maher and his eradication colleagues take to navigate these and myriad other challenges are astonishing – feats of logistics, diplomacy and detection that would not be out of place in a textbook.
“We’ve learned a lot about reaching every community, the most difficult access places, we’ve learned a lot about the importance about communicating what we are trying to achieve, to bring communities along with us in what we were doing. We’ve learned that there are certain things that are too big to do yourself. You need to build coalitions, you need partnerships to be able to make something happen, and the broader that partnership is, the greater the likelihood that you are going to be able to achieve something significant,” he said.
For Maher, the real risk is not that polio won’t be defeated, but that the world might one day forget how it was done. He sees the lessons learned during eradication as critical to the global health community.
“It would be a terrible pity if we lost that, if after eradication we kind of collectively heaved a sigh of relief and said, ‘well thank goodness that’s over, let’s do something else now’.”
The passing of former Secretary-General of the United Nations Kofi Annan earlier this month was a significant loss to the world of international diplomacy, peace, and efforts to deliver a more equitable life to millions worldwide. Charismatic, strongly opinionated, and perpetually kind, Annan captured the imagination of thousands working in international affairs across the world.
Beginning his career at the World Health Organization, he never lost sight of good health as a right owed to all. Sharp and precise, he was also quick to recognise and commit to public-private partnerships, and health investments which make social and economic sense – interventions which deliver a decisively positive return on investment.
The need to “reach every child” – no matter where – with a simple health intervention giving life-long benefits, was the principle that led him to commit so strongly to the global cause of polio eradication. Over the course of his tenure, he consistently and strongly supported polio eradication efforts in some of the most difficult settings worldwide.
In doing so, he bolstered the efforts of the programme, bringing us closer to a polio-free world, and enabling the 99.9% reduction in cases achieved since the beginning of eradication efforts.
Annan’s impact on polio eradication was both visible and invisible.
He supported the first-ever Global Summit on Polio Eradication during the UN General Assembly in 2000, and called for “greater mobilization of people and funds” and “commitment at the highest levels” in the race to reach the last child. He declared that polio eradication was a model for effective public-private partnerships in global health.
Staying close to his humanitarian principles, he urged Member States and all parties to cease hostilities to allow polio vaccination activities to continue in many regions of the world, and was unafraid to directly target the source of tensions. He was involved in securing access to vulnerable populations through ‘Days of Tranquillity’ in Iraq, the Democratic Republic of the Congo and Cote d’Ivoire. To support these critical vaccination campaigns, he directed the UN to provide logistical support, including the use of UN helicopters to deliver vaccines to the hardest to reach, and conflict affected communities.
Significantly, he appointed a Special Envoy for polio eradication in Nigeria in the early 2000s to help negotiate complex issues around a ban on polio vaccinations in areas of the country. This helped to resolve the issue, stemming a devastating spread of the virus that threatened global eradication efforts.
In 2000, Annan spoke of the wider impact of tranquillity days, “In war zones around the world, guns have fallen silent to allow immunization days to take place – demonstrating that even in the most intractable of conflicts, warring parties can call a halt to destruction in the cause of life.”
Lifelong commitment
Behind the scenes, he was quick to recognize the important contributions of donor states to eradication efforts, and maintained interest in the polio programme even during his busiest times in office.
Calling on WHO headquarters staff to provide briefing notes and regular updates, he kept key policy makers on their toes, and helped push the sense of urgency which continues to this day in the fight to eradicate polio. He actively sought polio talking points ahead of his travel to polio priority countries. Each year, he wrote to the heads of endemic states to thank them for their continuing commitment to defeating the paralysing virus, and urged them to take specific actions to strengthen operations.
Using his connections to the African Union, the Organisation of Islamic Cooperation countries, and the G7, he helped to inspire states to enhance their political commitment, and donate to the cause of ending polio. He was grateful for their support, as evidenced by numerous letters of thanks in the archives which chronicle his commitment to and belief in eradication.
A career diplomat, Annan was unafraid to use other methods of strengthening multilateral commitment. To the joy of communications specialists in the programme, he was ahead of the game in agreeing to take part in polio eradication videos, newspaper opinion editorials, and to launch polio vaccination campaigns with his wife, Nane.
Indeed, this was perhaps one of the most touching symbols of his commitment. Inspired by the commitment of polio eradication volunteers in the field, Annan continued to support the programme even after the end of his time as Secretary-General.
As a board member of the United Nations Foundation, and through his own foundation, he continued to advocate for polio eradication.
On the day that polio is declared eradicated, there will be many people to thank. Kofi Annan, this humanitarian, this diplomat, this visionary, will be one of those people.
Kofi Annan passed away on 18 August 2018. During his time as Secretary-General of the United Nations he made significant contributions to global health, global security, and global diplomacy. The Global Polio Eradication Initiative extends its condolences to his wife, children, family, and all those who worked with him, and were inspired by his life and work.
In April 2016, the polio programme embarked on a massive, coordinated effort to withdraw Sabin type-2 from routine use, through a synchronized switch from the trivalent formulation of the oral poliovirus vaccine (tOPV) to the bivalent form (bOPV). Over a two-week period, 155 countries and territories successfully made this change, marking the largest and fastest vaccine rollout in history.
Referred to as simply “the switch,” this global undertaking was a major programmatic achievement, but it was also a necessary step on the road to eradication. That’s because, in rare cases, the live, weakened virus contained in OPV can mutate and spread, resulting in cases of circulating vaccine-derived polioviruses (cVDPVs). The vast majority of these cases are caused by just one of the three components contained in tOPV (Sabin type-2 virus), so switching to a bivalent form that doesn’t contain this component was an attempt to significantly minimize the risk of further cVDPV2 cases – a decision that was endorsed by the global health community. Further, with Sabin type-2 responsible for 40% of vaccine-associated paralytic polio (VAPP) occurrences – a much rarer phenomenon at 2-4 cases per 1 million ‒ there was even stronger justification for the switch.
To assess whether the switch was successful, a group of researchers from Imperial College London, the World Health Organization and the Bill & Melinda Gates Foundation analysed stool and sewage samples from 112 countries collected in the first 15 months after the switch. The results, published in The New England Journal of Medicine, show that VDPVs and Sabin type-2 excreted into the environment after vaccination disappeared rapidly after the switch, shrinking to a much smaller geographic area.
These findings validate the GPEI decision to withdraw tOPV and demonstrate that the switch achieved its desired goal of reducing VDPVs and VAPP. This research also provides important evidence that the complete withdrawal of OPV after eradication of all wild polioviruses will eventually eliminate the risk of VDPVs, provided high immunity and effective surveillance are maintained. Eradication is simply not compatible with continued use of OPV.
The study also showed, however, that while some outbreaks of VDPV were expected post-switch, the number and magnitude of some of these outbreaks in different geographies has proven more difficult to control than expected. Type-2 VDPV outbreaks outside of Africa have been responded to with monovalent type-2 OPV (mOPV2) and controlled. However, outbreaks in the Horn of Africa, DR Congo and Nigeria have been very difficult to bring to a rapid close.
VDPV outbreaks emerge in areas with very low population immunity, due to low immunization coverage. Factors which enable them ‒ insecurity and resulting inaccessibility, weak health systems, and poor campaign performance – are the same that need to be addressed to stop their transmission. While the programme is aware of these risk factors and has proven experience and strategies to respond to them, the longer outbreaks persist, the harder they can be to stop.
The key to stopping these outbreaks will be to increase the focus on improving the quality of vaccination campaigns in accessible areas. In inaccessible areas, we need to use all available means to negotiate access and implement vaccination campaigns. Achieving high quality campaign activities will give us the best chance to stop all types of poliovirus for good and prevent any child from being paralysed by the virus ever again.
At Malahang health clinic near Lae in Morobe Province, a health worker administers the oral polio vaccine (OPV) at a supplementary vaccination activity targeting children under five years. As part of the health ministry’s response to Papua New Guinea’s recent polio outbreak, four additional rounds of OPV vaccination are planned in Morobe, Madang and Eastern Highlands provinces.
An aerial view near Lae, Morobe Province. Papua New Guinea’s first polio outbreak since 1996 was first identified at Lae. Low immunization coverage rates, poor water sanitation and hygiene all contributed to cases of circulating vaccine-derived poliovirus (cVDPV).
Officer-in-charge Daisy Basa (centre) checks a child’s vaccination card at the Malahang Health Clinic. More than 2900 health workers, vaccinators and volunteers have been mobilized to vaccinate almost 300,000 children under five years old in Morobe, Madang and Eastern Highlands provinces.
Locals in traditional dress provide entertainment for families attending the supplementary vaccination sessions at Malahang health clinic. A national public awareness campaign has played a key part in the Government’s comprehensive response to the polio outbreak, helping to maximise vaccine coverage of children under five years old.
The National Department of Health (NDOH) is leading efforts to limit the spread of the disease, in collaboration with WHO, GPEI and other partners. As well as the supplementary vaccination sessions, the National Public Health Emergency plan includes strengthening surveillance systems for early virus detection. WHO is supporting this work, ensuring swift investigation of every case of suspected polio paralysis.
Vaccine supplies are loaded into the cold room at the Morobe Province supply store in Lae. Thanks to the quick response of the National Department of Health (NDOH), along with WHO and other partners, thousands of children have already been vaccinated. Efforts continue to detect and protect against the virus.
Molvi Hameedullah Hameedi is a prominent religious scholar in a mountainous rural area of Killa Abdullah district, one of the poorest districts in Balochistan province, Pakistan. With a close connection to his community, who are mostly Pashtuns, he delivers the sermon each week during Friday prayers, and runs a religious seminary.
He is also a determined supporter of routine vaccination for all children, and an advocate for better health.
This might come as a surprise if you met Molvi Hameedullah just a year or two ago. For most of his life, he did not believe in the safety and effectiveness of the oral polio vaccine, the key tool of polio eradication.
“I was a religious scholar who was very sceptical of non-governmental organizations and the polio vaccine,” he reflects.
“After reading anti-vaccine books and papers, I began following the work of anti-vaccine campaigners. Soon, I came to consider it my religious duty to spread awareness against the polio vaccine.”
“But it all changed when I was invited to a two-day International Ulema conference in Islamabad where religious scholars from all over Pakistan and other Islamic countries were invited to debate polio vaccination.”
The conference Molvi Hameedullah attended was hosted by the Islamic Advisory Group for Polio Eradication (IAG). The IAG was launched in 2014 by leading Islamic institutions including Al-Azhar University, the International Islamic Fiqh Academy (IIFA), the Islamic Development Bank (IsDB) and the Organization of Islamic Cooperation (OIC).
For Molvi Hameedullah, attending the conference marked the beginning of a change in perspective. “At the conference, I was given an opportunity to discuss my apprehensions towards polio vaccine. The talks I had motivated me to further research the pro-polio vaccine stance, and I started meeting with religious scholars in Karachi to debate polio vaccination.”
“Through talking to these people, I was getting a completely different picture to what I had believed earlier.”
By educating religious leaders and scholars about the poliovirus, and explaining religious justifications for vaccine acceptance, the IAG and its national equivalent equip people like Molvi Hameedullah with the tools to act as health advocates. The same skills that help scholars engage with parents about the polio vaccine are applicable for wider health, including improving routine immunization, hygiene practices, and maternal and child health.
After the conference Molvi Hameedullah was offered support by other vaccine-promoting scholars.
“I received a book from a religious support person working for polio vaccination in my area. Included were dozens of fatwas from highly esteemed madrassahs and religious teachers. I was initially sceptical, so I telephoned the madrassahs who had written them. To my surprise, all the fatwas were genuinely issued by them, and they also urged me to support vaccination wherever I called.”
Today, Molvi Hameedullah teaches similar fatwas as a member of the Provincial Scholar Task Force under the National Islamic Advisory Group. Most Task Force members have an honorary position, and are not paid a salary. Instead, the local government facilitates their transport and communication needs during immunization campaigns. Of his new role Molvi Hameedullah says, “I was faced with a different problem. I had been working against polio vaccination for many years, and now felt that I had done a great damage to the children and parents of my community. I felt it was now my absolute religious duty to negate all that I had taught before. I decided to step forth, and started working in the community voluntarily to promote vaccination.”
Religious refusals in Molvi Hameedullah’s area have declined. He has begun supporting other ways of ensuring that every child receives a vaccine, including by recruiting women vaccinators.
He acknowledges that the work he does now is not easy. He and his fellow scholars sometimes face challenges from those accusing them of having a political agenda, and changing beliefs informed by years of cultural and religious tradition takes time and patience. But he vows to continue his new mission until eradication.
There have been no cases of polio in the area of the district that Molvi Hameedullah covers since he joined the Provincial Scholars Task Force. Looking ahead, he is determined not to stop until all of Pakistan is polio-free.
More than 25,000 members of Rotary clubs from 175 countries and territories gathered in Toronto, Canada this week for Rotary’s annual International Convention.
On the convention’s final day, Justin Trudeau, prime minister of Canada, was presented with Rotary’s Polio Eradication Champion Award in recognition of his leadership and Canada’s contributions to polio eradication. In his remarks to Rotarians, Trudeau highlighted Canada’s continued commitment to working towards a world without polio, a world with gender equity, and a world where everyone has a chance to succeed. He expressed a wish that his children would grow up in a polio-free world, and encouraged Rotarians to continue their important work to achieve eradication worldwide.
Rotary International President Ian Riseley presented the award to the Prime Minister, drawing attention to Canada’s recent pledge of C$100 million toward global polio eradication—made last year at Rotary’s 2017 convention—and noting that Canada had already fulfilled that commitment. He also recognized the Prime Minister’s leadership at the recent G7 summit, stating, “Prime Minister, we are grateful for your partnership: your personal commitment to polio eradication and your nation’s longstanding support of this historic effort. We promise that we will continue to do our very best to live up to that confidence —for the benefit of all the world’s children, now and forever.”
Progress toward global polio eradication was a recurring theme in major speeches and workshops throughout the convention, including a keynote address by World Health Organization Director-General Dr. Tedros Adhanom Ghebreyesus. In his remarks, Dr. Tedros thanked Rotarians for their tireless efforts and appealed for continued focus in the fight for a polio-free world, stating, “We cannot be complacent. We must finish the job. We must wipe polio from the face of the earth.”
The convention also featured a session highlighting the critical role women play in the global effort to end polio, including Rotary volunteers who have been involved in all aspects of polio eradication, such as immunization activities in the field, fundraising, public awareness, and advocacy. Thanks to an onsite virtual reality booth, attendees even had the opportunity to walk in the shoes of a volunteer immunizer in Uganda.
Since Rotary launched its PolioPlus program in 1985, the efforts of millions of Rotarians worldwide have helped reduce polio cases by 99.9%. PolioPlus has become the largest internationally-coordinated public health initiative in history. At the conference this week, it was clear that Rotarians around the globe are continuing to lead the way – ensuring that every last child receives a life-saving vaccine, and celebrating everyone committed to ensuring a polio-free world.
Following identification last month of an acute flaccid paralysis (AFP) case from which vaccine-derived poliovirus type 1 (VDPV1) had been isolated, genetic sequencing of two VDPV1s from two non-household contacts of the AFP case has now confirmed that VDPV1 is circulating and is being officially classified as a ‘circulating’ VDPV type 1 (cVDPV1).
The National Department of Health (NDOH) of Papua New Guinea is closely working with the GPEI partners in launching a comprehensive response. Some of the immediate steps include conducting large-scale immunization campaigns and strengthening surveillance systems that help detect the virus early. These activities are also being strengthened in neighboring provinces.
The GPEI and its partners are continuing to work with regional and country counterparts and partners in supporting the Government of Papua New Guinea and local public health authorities in conducting a full field investigation, risk assessment and to support the planning, implementation and monitoring of the outbreak response.
For more information:
Contact Oliver Rosenbauer, Communications Officer, Global Polio Eradication Initiative, tel: +41 79 500 6536
21 June 2018 – The Ministry of Foreign Affairs of the Republic of Korea announced today an additional US$ 2 million to fund polio outbreak response and surveillance activities in the Horn of Africa. This commitment makes Korea the first country to support outbreak response efforts in the region, critical to protecting global progress toward ending polio.
The Global Polio Eradication Initiative (GPEI) welcomed the contribution, with $1.5 million for UNICEF and $0.5 million for WHO.
This funding was raised through an innovative financing mechanism called the Global Disease Eradication Fund, through which KRW₩1,000 was collected from each international passenger flying out of Korean airports by the Government of Korea. Thanks to this Fund, every passenger flying from Korea directly supports global efforts to stop polio, an infectious disease that can lead to paralysis or even death, and can travel long distances undetected.
When the GPEI first began in 1988, polio paralysed more than 350,000 children each year in over 125 countries in the world. Today, there have only been eight cases to date in 2018, and polio is closer than ever to becoming the second human disease to ever be eradicated.
This progress is made possible through the ongoing support of donors, partners, and countless health workers around the world. Contributions from donors like Korea allow the GPEI to vaccinate and protect more than 450 million children against polio each year.
This additional funding follows a US$ 4 million commitment from the Republic of Korea announced at the Global Polio Pledging Event around the Rotary International Convention in June 2017. This contribution was matched by the Bill & Melinda Gates Foundation, doubling its impact to US$ 8 million.
“The Global Disease Eradication Fund is an incredibly innovative financing mechanism, and the funds raised will support UNICEF’s efforts to protect every last child from polio,” said Akhil Iyer, UNICEF Director of Polio Eradication. “We remain grateful to the Republic of Korea for their continued commitment to halting polio outbreaks and driving progress to eradicating polio once and for all.”
“The unique support of the Republic of Korea has been crucial for the remarkable progress we have made in polio eradication, especially in responding to outbreaks,” said Dr Michel Zaffran, Director of the Polio Eradication Programme at the World Health Organization. “These additional funds come at a critical time as we support the outbreak response in the Horn of Africa region by scaling up surveillance to ensure no virus goes undetected.”
The Republic of Korea has been a longtime supporter of the GPEI, contributing to outbreak response efforts in Syria, the Democratic Republic of Congo and the Lake Chad region, with a broad range of activities including delivering polio vaccines, intensifying surveillance, and convincing caregivers to vaccinate their children through community engagement.
Generous support from donors like the Republic of Korea remains essential to stopping outbreaks, ending this paralysing disease and ultimately achieving a polio-free world.
A pale blue sky stretches from east to west. The ground is dusty, the journeys of thousands of people compacting it into a hard dirt track. Ahead stands a structure known as the Friendship Gate – with people laden with bags and boxes weaving paths beneath it. This isn’t an ordinary street, but a border crossing between Afghanistan and Pakistan, where people, goods, livestock, and sometimes, the poliovirus, pass from one country to the other.
Porous borders, which enable the continuous movement of people between countries, are a contributing factor to poliovirus transmission in Afghanistan and Pakistan. Along with Nigeria, these are the only wild poliovirus endemic countries in the world. Look at a map of poliovirus cases and positive sewage samples over time, and transmission ‘corridors’ can be clearly seen, evidence of the virus passing consistently between the countries. Every year for decades, the virus has made it over the border through key entry and exit points, hiding in children.
Spin Boldak in southern Afghanistan and Chaman in western Pakistan are both important border crossing points centrally positioned in what is known by epidemiologists as the ‘southern corridor’. Today, thanks to collaboration between the governments of Afghanistan and Pakistan, and the efforts of hundreds of thousands of individuals working to fight the virus, this important crossing is attended by polio vaccinators, seven days a week, 24 hours a day. With two drops of safe, effective vaccine, they ensure that every one of the thousands of children under the age of ten entering the other country each month leaves the poliovirus behind.
To defeat the virus, polio eradicators seek to understand the push and pull factors of people crossing the border. Many are traders, some seek medical treatment in Pakistan, others visit relatives on both sides of the border. Many have sought refuge in Pakistan, or are forced returnees. Many come from areas where health systems are weak, and some children have never been vaccinated before.
To defeat the virus, Afghanistan and Pakistan have built strong relationships. Studded along the border – which weaves from north to south, through mountainous areas, deserts, and between busy cities– are 15 WHO and UNICEF supported vaccination posts, hosting 42 vaccination teams. Each month, they vaccinate tens of thousands of children for free, no matter what their nationality or reason for being at the border.
Dressed in Rotary ‘End Polio Now’ hats, and surrounded by bright banners, the cross-border health workers also watch out for children travelling across the border presenting signs of acute flaccid paralysis, an indicator of potential polio infection. Vaccinators also speak to parents, educating them about the importance of vaccines, and the other immunization services that they can get free-of-charge in the country they are crossing to. For many without free professional health-care, this is a crucial service. Most arrive unaware of the benefits they can gain to protect their children’s health, and this information is not always easy to come by.
The polio programme also works with other humanitarian organizations near the border. As the situation changes, with refugee numbers fluctuating accordingly, the vaccination teams work to ensure children can be reached at or near the border, with few missed. In April, 2289 children under the age of ten, mostly from Pakistan and Iran, were vaccinated near the border with oral polio vaccine by teams receiving them into UN Refugee Agency (UNHCR) repatriation centers and sites run by the International Organization for Migration (IOM).
Polio vaccination at the border prevents the reintroduction of the virus into areas of Afghanistan and Pakistan where no cases or environmental positive samples have been seen for some time, and reduces incidence of the virus in areas where it is still circulating. Our team gives every child a strong start in life – whether they are a refugee or a returnee, and irrespective of their place of origin. As the team in Spin Boldak and Chaman finishes its shift for the day, the next team continues their task: to protect all children at the border, and help end polio.
