The Pakistan polio snapshot gives a monthly update on key information and activities of the polio eradication initiative in Pakistan.
In March:
In March:
For full update please click on pdf below.
We talk to Professor Rose Leke, Chair of the African Regional Certification Commission, to get her views on progress on the continent, and prospects for certifying the region polio-free in 2019.
The Pakistan polio snapshot gives a monthly update on key information and activities of the polio eradication initiative in Pakistan.
In February:
The Afghanistan polio snapshot gives a monthly update on key information and activities of the polio eradication initiative in Afghanistan.
In February:
For full update please click on pdf below.
Zulaihatu Abdullahi is well known in her community, particularly to the mothers. As a volunteer community mobilizer in Kaduna state, northern Nigeria, her mission is to ensure that no child contracts polio, or any other preventable childhood disease.
This is difficult, as immunization programmes are sometimes treated with suspicion in her part of Nigeria. As a ‘change agent’, Zulaihatu’s job is to go door to door, counselling parents about the importance of the polio vaccine.
This particular lunchtime, she is visiting an 18 year-old mother living in a compound in a densely-populated, urban district of Kaduna State.
The young mother puts down the pole she is using to pound millet and welcomes Zulaihatu, recognising her royal-blue UNICEF hijab. She sits, and pulls on a hijab for cover as she settles down to breastfeed her baby. She has three other small children at home, a fifth on the way and she is new to the area.
“Before I came here I was rejecting all vaccines,” she says, “but because of this woman, Zulaihatu, I decided to accept. She told me the usefulness and I was convinced to do it.”
Thanks to Zulaihatu’s patience, and her work to build trust with the younger woman through regular visits, four more children are now protected against polio who might otherwise still be at risk. The mother has also been encouraged to seek anti-natal care, and the youngest child has just received his routine immunization shots.
“Sister Zulaihatu was one of the first women I met when we moved here,” the mother recalls. “She came here every day. She told me how she takes care of her own children. What she feeds them. How they all take vaccines. Little by little I started to change my thinking.”
Zulaihatu is trained to make her community aware of important household and parenting practices to keep their children thriving. The list is extensive and includes tips to treat diarrhoea, the importance of basic hygiene and sanitation, how to protect the family from malaria, the benefits of neonatal care and breastfeeding for infants, and the importance of registering their births.
She is one of nearly 20 000 UNICEF-trained community mobilizers, influencers and communication experts spread across 14 northern ‘high risk’ Nigerian states. With the support of donor and partners including the Bill and Melinda Gates Foundation, CDC, Dangote Foundation, European Union, Rotary, GAVI, JICA, the World Bank and the Governments of Canada, Germany, Japan, and others, the mobilizers are a key part of UNICEF’s ongoing support to the Government of Nigeria’s immunization programme.
Despite their achievements, Zulaihatu and other mobilizers know that there is much is still left to be done in their communities. Tomorrow, Zulaihatu will continue her work, going from household to household to keep every child safe.
In eastern Afghanistan, one family is helping to vaccinate every last child in their community
Zahed, his daughter Sahar, and son Mohammad all work together. But they are not working for themselves, they are working to eradicate polio.
The family lives in an indigent village in eastern Afghanistan with a diverse community. It is close to the border with Pakistan and many residents are returnees from Pakistan, families displaced by insecurity and nomads passing through. With a population that is often on the move, it is a community with high risk of poliovirus transmission – making it extremely important to vaccinate every child.
Zahed’s family are well-known. Each month, they knock on doors giving free vaccinations and educating their community about the virus.
Although sometimes they don’t have doors to knock – only tents. Known in Afghanistan as Kuchis, nomads are particularly vulnerable to polio, because they move seasonally and often miss vaccination campaigns. Historically underrepresented and often neglected, they are also isolated from health services.
Nomads at risk
Laden with water jugs, cooking equipment and clothes, the Kuchi travel with their livestock and move between provinces depending on the climate. Their goats, sheep and camels are often exchanged or sold for grain, tents and other essential items. There are an estimated two million nomads in Afghanistan.
Over 120 nomad families with 194 children under the age of five recently arrived in Zahed’s village from shelters along the Kabul River. They come in the winter because it offers warmer, more fertile ground for their animals to graze. They return to Kabul and Bamiyan during the spring, when the land is more arable.
To eradicate polio in Afghanistan, every child must be vaccinated – including the nomads. And this is exactly what Zahed’s family are doing. They go to each tent, and ensure every child is protected against polio. Last week, Zahed’s 20-year-old son Mohammad vaccinated 719 children, including nomads. “My community are happy with my service. I’m young, and it is a privilege to make a difference,’’ says Mohammad.
The family is not only protecting children, they are also contributing to community cohesion and bridging divides between nomads and residents. The challenge, however, is continuing to vaccinate nomads when they are on the move.
The motivation of Zahed’s family is impressive, but it is not always easy. A handful of people in the village reject the vaccine because they think that it is unsafe or not halal – permissible in traditional Islamic law. But watching an entire family working to eradicate polio helps break misconceptions. At the start of each vaccination campaign, Mohammad gives one of his own children the vaccine to prove that it is safe.
Becoming advocates
Zahed’s family have turned almost all the families who were refusing the polio vaccine into advocates for vaccination. Mohammad was already a prominent member of the community and was previously given a ‘Turban’ – headwear used to recognize a person who makes decisions on behalf of their community and country – to honour his relentless work to improve water, sanitation and development in his village. Now his role as a polio eradication ambassador is developing trust and increasing acceptance of the vaccine.
In 2017, three polio cases and 14 positive environmental samples were reported in eastern Afghanistan. A positive sample indicates that the polio virus is present, and that children with low immunity are at risk of contracting the disease. The first polio case of 2018 was also reported in eastern Afghanistan, making it an urgent priority location for nationwide eradication.
In the village, polio has almost been eradicated. But this is not enough for Zahed’s family. As they prepare for their next vaccination round, they are determined not to stop their work until everyone in their community – wherever they are from – is safe from polio.
The Pakistan polio snapshot gives a monthly update on key information and activities of the polio eradication initiative in Pakistan.
In January:
The discovery of wild poliovirus in Borno and Sokoto states in Nigeria in 2016 after more than two years without any reported cases prompted a multi-country response in neighbouring countries of the Lake Chad basin, covering Cameroon, Central Africa Republic, Chad, Niger and Nigeria. Since the outbreak response started, coordinated vaccination campaigns have been taking place in all five countries, reaching tens of millions of children. This year, campaigns are planned for March, April and October – all of them synchronized between the neighbouring countries.
In Chad, vaccination activities for polio and other diseases are being carried out in priority districts, supplementing regional campaigns which aim to target the hardest-to-reach children.
A child is vaccinated in a nomadic camp in the village of Ngouboua, in Chad’s north-west region. Additional vaccination activities have taken place in priority districts in Chad between regular campaigns to help strengthen the immunity of children under five.
Teams make dedicated efforts to reach children from difficult-to-access populations: particularly nomadic and island-dwelling families who are often not reached by routine health services, as well as returnee, displaced and refugee populations with limited access to regular vaccination.
Health centers in Chad’s 11 priority districts are supplied with routine vaccines including tuberculosis vaccine, polio vaccine, pentavalent, and measles vaccines, so that trained health workers can vaccinate all children from 0 to 11 months against vaccine-preventable childhood diseases, using fixed, advanced and mobile vaccination strategies.
Vaccinator teams use creative approaches to access hard-to-reach and at-risk populations. Children are being reached with polio and other critical vaccines through vaccinator outreach in areas including weekly markets, islands, and at refugee, displaced and returnee camps.
WHO, UNICEF and partners in the Bagasola district navigate through islands to deliver vaccines to the most vulnerable remote communities.
There are hundreds of islands within Lake Chad that are hardly accessible to health workers. Efforts to specifically reach these locations have been made a national priority.
The Blarigui community meets with the Canton (sub-region) Chief and the vaccination team responsible for the Reaching Every District strategy in the Bagasola region, prior to a special campaign in 2017.
In Chad, engagement of communities and their leaders is key to reaching every child. During immunization campaigns, social mobilizers and the community meet and discuss the importance of vaccination, a practice that has proven successful to increase trust among parents and communities towards vaccinators and campaigns.
Recommendations to bolster the multi-national regional outbreak response across the Lake Chad basin have highlighted the need to improve operations in hard-to-reach areas. In Chad, health workers have been trained to make better use of campaign micro-plans, which map the location of every household, and ensure that each is visited by vaccinators during a campaign. All under-fives living in the high-risk districts of the Lake Chad basin have also been recorded in an community register, helping to ensure that every child receives two drops of polio vaccine in each vaccination round.
More than 4.5 million children under five were reached through national vaccination campaigns in Chad in 2017. Among these, thanks to the renewed focus on identifying and reaching missed children, more than 215,000 were vaccinated from the priority districts of the Lake Chad basin region - particularly those who reside on difficult-to-access islands within the geographical boundaries of Nigeria.
A health worker provides a dose of pentavalent vaccine to a child during an outreach immunization session in Chad. As part of the intensive vaccination campaigns, teams are reaching children with more than just polio vaccine – bringing broader benefits to remote and hard-to-reach communities and maximizing the reach of the polio network.
As he climbs out of his car and walks across to the entrance of Bakassi camp for internally displaced persons in Borno, northern Nigeria, Dr Terna Nomwhange is met by a familiar sight. Standing at the gates, greeting a tired, dusty family laden with possessions, is a team of polio vaccinators. As families arrive at this sea of shelters following a long, hard journey, these people offering polio vaccines are the first sign that they have reached a place of protection.
Not only are families in northern Nigeria facing insecurity, a humanitarian crisis and the threat of polio, but since September they have also been at risk from an outbreak of yellow fever. By early January 2018, a total of 358 suspected cases had been reported in 16 states, with 45 deaths recorded for 2017. In Borno, the ongoing conflict means that the health infrastructure on the ground to respond to the outbreak is limited to local government and the polio eradication infrastructure.
At the camp gates, the polio vaccinators give two drops of vaccine into the mouth of every child; but they also tell the parents where to go to get their yellow fever vaccination. As Dr Terna, who works for the WHO Nigeria polio eradication programme, walks further into the camp, he catches sight of the distinctive blue that signifies the uniform of a polio volunteer community mobilizer. As she emerges from the door of a shelter, he hears her reminding the family within to get their children vaccinated against polio, but also for the whole family to be vaccinated against yellow fever.
With weakened health system in parts of north eastern northern Nigeria, the infrastructure that is already on the ground to stop polio is providing the volunteers needed to support the yellow fever vaccination campaign. More than eight million people are being targeted with yellow fever vaccines in the states of Borno, Zamfara Kwara and Kogi states in 2018.
Regular polio vaccination campaigns reach children under five years of age with polio vaccines, as this age group is the most vulnerable to the virus. But reaching everyone between nine months and 45 years to protect them against yellow fever takes creative thinking. People who would not usually be vaccinated have to be mobilised to come to health clinics where they can receive that one shot of yellow fever vaccine that infers life-long protection.
This is where the polio infrastructure comes in. To prepare for the launch of the yellow fever vaccination campaign that took place at the beginning of February, polio experts supported the preparations by developing detailed microplans, mapping each community so that every individual can be vaccinated. Volunteer community mobilisers, well versed in educating communities about the risks of infection, used their skills to warn populations of the high mortality rates associated with yellow fever.
The polio surveillance system in Borno is already on high alert to identify any case of polio, even in conflict affected areas. “Surveillance remains everyone’s number one priority,” says Dr Terna. “While the polio infrastructure is doing everything it can to find any trace of polio, it is killing two birds with one stone by keeping an eye out for yellow fever as well. This is a win-win situation to stop both diseases.”
While surveillance focal persons move house to house, they are also raising awareness about the symptoms of yellow fever. When a potential case is found, the polio infrastructure is being used to collect blood samples and transport them to the national laboratory down the reverse cold chain, keeping samples at the correct temperature for testing.
“What makes this campaign special is not just the fact that the strong polio infrastructure is helping to control other diseases, but also that it underscores what can be achieved with intersectoral collaboration and partnership,” said Dr Wondimagegnehu Alemu, WHO Country Representative to Nigeria. “Without the polio eradication infrastructure, a campaign of this scale would not have been able to take place.”
“Everyone is pulling in one direction – the government, partners and volunteers within communities – to protect any and every vulnerable person against polio and yellow fever,” says Dr Aliyu Shettima, Polio Incident Manager at the Emergency Operations Centre (EOC) in Maiduguri.
Support for immunization to the Federal Government of Nigeria through the World Health Organization is made possible by funding from the Bill & Melinda Gates Foundation (BMGF), Department for International Development (DFID), European Union (EU), Gavi, the Vaccine Alliance, Global Affairs Canada (GAC), Government of Germany through KfW Bank, Japan International Cooperation Agency (JICA), Korea Foundation for International Healthcare (KOFIH), Measles and Rubella Initiative (M&RI) through United Nations Foundation (UNF), Rotary International, United States Agency for International Development (USAID), United States Centers for Disease Control and Prevention (CDC) and World Bank.
The Afghanistan polio snapshot gives a monthly update on key information and activities of the polio eradication initiative in Afghanistan.
In January:
For full update please click on pdf below.
The Pakistan polio snapshot gives a monthly update on key information and activities of the polio eradication initiative in Pakistan.
In December:
The Afghanistan polio snapshot gives a monthly update on key information and activities of the polio eradication initiative in Afghanistan.
In December:
For full update please click on pdf below.
The Afghanistan polio snapshot gives a monthly update on key information and activities of the polio eradication initiative in Afghanistan.
In November:
For full update please click on pdf below.
The Pakistan polio snapshot gives a monthly update on key information and activities of the polio eradication initiative in Pakistan.
In November:
The Islamic Advisory Group for Polio Eradication has launched a new training manual for students of religious studies in support of polio eradication efforts. The manual provides practical guidance on how to engage with local communities to advocate for vaccination as well as other maternal and child health issues.
The launch of the training manual follows Islamic Advisory Group’s efforts to prepare students of religious studies at key universities in predominantly Muslim countries to act as advocates for critical health initiatives particularly in high-risk areas where marginalized and underserved populations reside. As future religious leaders and scholars the students will be well placed within their local communities to promote healthy behaviour and dispel rumours and misinformation that hamper the work of vaccination teams and deprive their community members of protection against polio and other vaccine preventable diseases.
“I was told that if the child was vaccinated against polio, he could one day become a great footballer like Drogba and Yaya Toure…Today, they have not yet become like Drogba and Yaya, but they are in good health.”
– Awa B., mother of five children, Côte d’Ivoire
Today, the countries most vulnerable to poliovirus outbreaks are those where the barriers to effective immunization are most acute. In high-risk countries like the Central African Republic and Côte d’Ivoire, populations are hard to access and persuading communities of the need to vaccinate can be difficult.
For polio workers in these countries, it is important to reduce outbreak risk through strategies that involve local people, and which are receptive to the local surroundings and culture. Not every child will grow up to be a champion footballer, but by persuading parents of the importance of immunization, they can grow up active and healthy, protected from the debilitating effects of polio.
The Central African Republic and Côte d’Ivoire are both considered outbreak risk countries due to their difficult political and security situations, weak health-care systems, and regular cross-border population movement.
Geographically close to Nigeria, one of the last three polio endemic countries, the Central African Republic is currently at risk of virus spread from Borno state where there was a poliovirus outbreak in 2016. In 2011, Côte d’Ivoire experienced an outbreak of wild poliovirus type 3, also originating from Nigeria.
Outbreak prevention is a central part of the strategy to end polio, as the spread of the poliovirus through under-immunized populations could make eradication more of a challenge. In high risk countries where delivering vaccine can be difficult, different methods must be used to comprehensively immunize every last child.
In Côte d’Ivoire, a round of National Polio Vaccination Days officially began on October 28th in Ebimpé, marked by a ceremonial gathering of vaccination partners alongside key members of the local community. Speaking at the event, the Minister of Health and Public Hygiene, Dr Raymonde Goudou Coffie, described the need to vaccinate every last child as a mission for everyone: “Traditional leaders, heads of households and communities need to be involved in this initiative.”
This is a powerful method of engagement – making sure that parents and local leaders, as well as health workers and volunteer vaccinators, are involved in the fight against poliovirus.
Vaccinators also understand that no single approach will fit every situation. Instead, the Global Polio Eradication Initiative partners and field workers must work hard to understand how best to communicate the risk of polio outbreaks to different communities.
For instance, to reach parents working in Nana Mambere prefecture of the Central African Republic, local radio station SIRIRI hosted a panel based radio discussion to mark the recent vaccination campaign. Featuring medical professionals and local politicians, the panel addressed community worries around vaccine, urging every parent listening to take their young children to be immunized.
The day before the October campaign in Côte d’Ivoire, an advance team of volunteer vaccinators in Grand-Bassam began vaccinating at the local weekly market. Knowing the routine of local women, they anticipated that there would be some children visiting the market with their mothers who might not be reached later in the week – making this gathering of the community too good an opportunity to miss.
Having an understanding of the communities targeted in campaigns, whether of their worries around vaccination, or even parents’ weekly schedules, is crucial to effectively reduce the risk of a polio outbreak.
In Côte d’Ivoire, Dr Bamba Souleymane, Departmental Director of Health in Grand-Bassam, noted the quantity of different health interventions that his team was attempting to successfully deliver. Alongside the polio vaccine, the volunteers were distributing impregnated mosquito nets, de-worming medication, and vitamins.
Such combined efforts use the GPEI’s well-established infrastructure to deliver a variety of desirable health benefits in communities, not polio vaccine alone. In places where the health infrastructure can be weak, the polio programme’s ability to reach remote children can be a big advantage for many reasons.
For Awa, the dream of her son becoming a champion footballer was a persuasive reason to take him to be vaccinated. For others, receiving different health benefits or hearing information via radio are compelling reasons to vaccinate their children.
Lowering the chance of an outbreak is never a straightforward process, but instead requires understanding parents, children, and communities.
The best vaccinators and campaign planners are able to spot opportunities to keep campaigns relevant, access groups in different ways, and ensure that coverage is sustained.
This way, we can successfully protect every last child.
The Afghanistan polio snapshot gives a monthly update on key information and activities of the polio eradication initiative in Afghanistan.
In October:
The Pakistan polio snapshot gives a monthly update on key information and activities of the polio eradication initiative in Pakistan.
October updates include:
Malik is one of the hardworking vaccinators making sure that even children on the move are protected against polio.
The poliovirus knows no borders, making children on both sides of the border between Afghanistan and Pakistan vulnerable to contracting the debilitating disease. This is why, placed strategically along the border, 19 WHO-supported vaccination posts reach children on the move as they cross between countries, ensuring that all children under the age of 10 receive two drops of the oral polio vaccine to protect them from polio.
One of these teams is led by Malik, who has worked for the polio eradication programme for 14 years.
“I wanted to join the eradication programme when I heard that polio is a contagious disease that affects children. I wanted to serve children and our community. I learned about polio on the TV and radio and the health workers who came to our home to share information about the virus.”
Protecting children on the move
Malik started working as a vaccinator and has now worked as a team supervisor for the past 10 years.
“I am proud when we can reach every child and when I see my team vaccinating children, making sure that no child is missed. This makes me very happy,” he says.
Cross-border vaccination teams are crucial in the fight against polio. The Torkham border between Afghanistan and Pakistan, in eastern Nangarhar province, is one of the busiest border crossings in Afghanistan. Currently 38 WHO-supported vaccinators work in three shifts, operating 24 hours a day, 7 days a week.
“Today I started my work at 5.30 am. When we arrive at work in the morning, I gather the team together and we go through any issues that arose in the previous shift. We revise the schedule of the day and I assign teams to their specific locations. We have three locations at this border where we vaccinate all children coming to Afghanistan and those who are leaving.”
Checking for signs of polio
Since January 2017, WHO and partners have vaccinated over 44 000 Afghan children under the age of 10 crossing the border to Afghanistan from Iran and Pakistan. Over 25 000 of these have been vaccinated at the Torkham border’s so called “zero point” – the first point where Afghan refugees and returnees returning from Pakistan arrive.
“We focus a lot of finding cases of acute flaccid paralysis, sudden onset of floppiness in the limbs that is a sign of polio. We check children in all the vehicles that arrive at the border and work hard not to miss any potential polio cases,” Malik says. “When the trucks park here, we talk to the parents and ask about any possible cases of paralysis in the family. We also educate them about the importance of vaccines and tell them about the routine immunization services that are available free-of-charge in Afghanistan’s health facilities.”
Building trust
Most caregivers crossing the border to Afghanistan accept the polio vaccine but challenges remain.
“Sometimes we see parents who refuse to vaccinate children. We try our best to convince them to vaccinate by telling them more about the benefits of the polio vaccine and how polio cannot be cured. Those who refuse to vaccinate their children often don’t understand what the vaccine is or how it is essential for protecting their children,” Malik says.
Despite difficulties and his demanding work in a challenging environment where the security situation can shift quickly, Malik and his team are determined to continue the fight against polio.
“Afghanistan is still polio-endemic and the virus is deadly,” he says as he leads his team to approach another truck that crossed the border into Afghanistan. “I want to deliver these crucial services, serve my community and protect vulnerable children.
“I am the king of this village! Every child belongs to me and I will spread my poison to a new person every day,” screams the snake, bursting onto the stage.
In the audience, children gasp and jump backwards, their eyes wide.
Hamid, clutching his precious box of vaccines, attacks the snake, managing to defeat him. The crowd cheers.
“Vaccinating your children will destroy this disease!” cries Hamid. “Make sure your whole village takes these droplets and you will see how strong you and your children can be.”
This poisonous snake – mor zaharia as it’s called in Dari – represents the dangerous threat of polio, a disease that Afghanistan is fighting hard to eradicate.
Hamid leads a touring youth circus group made up of children and teenagers from all across the capital, Kabul, who performs juggling, acrobatics and theatre routines for local audiences around the city and beyond.
Today the circus is in Qargha, Kabul, Afghanistan. It was started 14 years ago by Mobile Mini Circus for Children and is supported by UNICEF.
The circus enables the children who join – often from internally displaced communities around Kabul – to go to school every day and then practise circus skills at their centre after school and on weekends.
Part of their impressive performance includes passing on vital messages about healthcare and social issues to the audience, who may otherwise not have access to this information.
“Our circus is entertainment and it is so much fun for the performers and for the audience,” says Hamid.
“We pass on these important messages in a fun way which people listen to and they understand. Giving a message without fun means people will not take that message away.”
This is especially true of the children, who flock to the circus the moment they see youngsters their own ages pull out their juggling sticks and begin clowning around on the makeshift stage.
“We often perform in the internally displaced persons camps,” says Hamid. “These areas are not peaceful and the people have no proper shelters, no electricity and no running water.”
These conditions provide the perfect environment for communicable diseases like polio to spread; yet a simple oral vaccination, just two drops in the mouth, can bring a child closer to a life without polio. Children in Afghanistan will be vaccinated against polio multiple times, until the disease is stopped for good.
During the August and September 2017 National Immunization Days 9.9 million children under five across Afghanistan were targeted with repeat doses of the oral polio vaccine.
The Pakistan polio snapshot gives a monthly update on key information and activities of the polio eradication initiative in Pakistan.
September updates include:
The Afghanistan polio snapshot gives a monthly update on key information and activities of the polio eradication initiative in Afghanistan.
In September:
A force of determined women already involved in the fight against polio has been assembled to lead work to curb the spread of a cholera outbreak in northeast Nigeria. Displaced by conflict and themselves living in camps around the crisis region, these women are moving from tent to tent to help families understand the risks they face during the rainy season, and how to get help if they fall ill.
Volunteer community mobilisers are often the only way community members know how to keep their families healthy in the face of extreme hardship.
These dedicated volunteers provide their neighbours with this vital service while facing their own hardships brought on by displacement.
Volunteer Community Mobilizers play a crucial role in helping to prevent the spread of cholera.
Zara uses a poster to demonstrate the most effective ways to avoid cholera.
Amina talks to her neighbour about how to prevent cholera in Muna Garage Camp.
Adama is an active participant in the campaign to prevent the spread of cholera.
A group of displaced families listens to a talk about the importance of handwashing with soap.
