GPEI-Donors pledge to strengthen immunization and accelerate fight against COVID-19

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

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

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

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

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

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

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

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

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

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It was a somber day when Ihsanullah was told that two of his youngest children will never be able to walk again. His two year old daughter Safia, and Masood, his five month old son, were both diagnosed with polio.

When they began running a high fever in December, Ihsanullah rushed them to the nearest hospital in the city of Tank, Pakistan. After a series of tests, doctors confirmed that both children had contracted polio. Further investigations revealed that neither child had been vaccinated during any previous routine immunization or polio campaign rounds.

Like many other parents in his village, Ihsanullah had never accepted the polio vaccine. “I had a negative opinion about vaccination from the start. Many people told me that the polio vaccine was made of haram[forbidden] ingredients and was part of a larger conspiracy to make Muslim children sterile,” he said.

A farmer and labourer by profession, 27-year-old Ihsanullah lives in a village named Latti Kallay in Khyber Pakthunkwa, Pakistan. Polio teams often face hesitancy from communities in Latti Kallay during campaign rounds, with many parents citing religion as the primary reason for refusing the polio vaccine. In Tank city and the immediate surrounding areas, six wild polio virus cases were reported in 2019.

Sadly, it sometimes takes a case of polio for communities to fully realize the importance of vaccinating their children. Asghar and Khadim, neighbours of Ihsanullah, told polio teams that they had started ensuring that their children are vaccinated, despite being staunch refusers of the vaccine previously.

Ihsanullah said, “It pains me to imagine that Safia and Masood will never be able to walk again. If I knew that this would be the outcome, I would never have stopped the polio teams from vaccinating my children. I deeply regret my decision, but I will make sure that my other children are vaccinated”.

For now, the COVID-19 pandemic has necessitated the temporary pause of polio vaccination campaigns. This leaves unvaccinated children who cannot access routine immunization services vulnerable to paralysis. The situation also underlines the vital importance of increasing trust in vaccines amongst parents, so their children are protected from polio no matter what happens.

Gohar Mumtaz, the Union Council Polio Officer of the district, has hope. He says that a routine immunization session with the community, conducted before the pandemic spread to Pakistan, seemed to be more popular than usual. “Although there is still hesitancy, the situation seems to be improving. People will understand the need to vaccinate and no child will suffer like Safia and Masood in the future.”

To overcome barriers to polio eradication, the Pakistan polio programme conducted a top-to-bottom review during 2019. Areas where improvement is required were identified, and innovations introduced. This is vital work, as there are many other children in Pakistan besides Safia and Masood whose futures have been marred by the poliovirus. Last year saw increased transmission of the poliovirus across all provinces with a total of 147 wild cases reported.

The COVID-19 pandemic has added an additional hurdle to defeating polio in Pakistan. It is vital that the programme makes up for lost time as soon as it is safe to conduct house-to-house vaccination activities again. Whilst the pandemic is ongoing, the programme continues to build trust with communities by providing information about COVID-19 as well as the poliovirus. Where routine immunization continues in health centres, polio personnel are emphasizing the importance of maintaining children’s vaccination schedules as far as possible.

In a time when our health feels especially precious, Ihsanullah, Safia and Masood’s story serves to remind us why vaccination is so important.

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The NEOC “Sehat Tahaffuz 1166” Helpline provides lifesaving information. ©UNICEF Pakistan/2020/Sharmin

“How can I help you?” Pause. “Have you travelled out of the country recently?” Pause. “Please stay on the line. I am connecting you to a doctor,” says a young woman reassuringly to someone at the other end of the line.

The call operator works at the ‘Sehat Tahaffuz 1166’ COVID-19 Helpline Centre at the National Emergency Operations Centre (NEOC) for Polio Eradication in Islamabad, Pakistan.

Until last month, Sehat Tahaffuz 1166 was a polio eradication helpline to help caregivers share concerns and receive accurate information about polio and other vaccines. As the pandemic spread, the Government expanded the centre to fight COVID-19.

A vital support system during a difficult time

Like many other countries, the global outbreak of COVID-19 poses an enormous challenge to health services in Pakistan. The Sehat Tahaffuz 1166 call centre is increasingly becoming an important platform to listen to the concerns of people, provide correct information, and connect them to a doctor when required.

Sadia Saleem (24), a proud Helpline agent. ©UNICEF Pakistan/2020/Sharmin

“I received a phone call from a 75-year-old man this morning. He was so scared and confused because of the coronavirus situation. He asked if sunbathing could help him stay protected from the virus,” said Sadia Saleem, a 24 year old helpline agent. “I explained to him the symptoms of the virus, and the preventive measures. He seemed relieved and thanked me,” she added.

Sadia is one of the 55 call agents currently supporting the helpline, which operates in shifts, from 8am to midnight every day, seven days a week.

“I’ve been working for the 1166 helpline since its inception. It’s stressful work but I feel proud that I’m serving the people during this challenging time. In addition to receiving reliable information, I think most people feel some comfort just speaking with someone from the health system,” said Sadia of her experiences.

Alongside the agents, the government has assigned six doctors to support the Helpline. Dr. Rabia Basri is one of them.

“I am forwarded calls that are critical and need expert medical advice. Every day, I receive about forty calls, some twenty minutes long. These are difficult times for everyone. I often advise people about personal hygiene and physical distancing, and if they are having symptoms, help connect them with a hospital for the coronavirus test and further medical support,” said Dr. Rabia.

Dr. Rabia Basri is one of six doctors stationed at the Helpline, responding to critical calls with expert medical guidance and referrals. ©UNICEF Pakistan/2020/Sharmin

70,000 calls a day

“Initially, we were receiving about a thousand calls a day. During the National Polio Immunization Campaign in February 2020 for example, people were calling to report missed children, clarify doubts about vaccines and lodge complaints when health and vaccine services were not working,” said Huma Shaukat, the Helpline Liaison Officer.

However, since the outbreak of COVID-19, the call volume has increased dramatically, to about 70,000 calls a day.

“Each call agent responds to about 150 callers a day. To increase the capacity of the helpline, thirty more agents have joined to manage the growing number of calls,” added Huma.

Despite adding more agents, the call volume has become unmanageable for the helpline centre. The situation has prompted the government to assign additional resources. The Digital Pakistan initiative of the Prime Minister’s Office is helping recruit an additional 165 agents while the National Institute of Health is assigning ten more doctors to the technical team.

Managing the 1166 helpline centre

“Training and commitment of call agents are very important. Otherwise the helpline will not work,” said Huma. “We have four supervisors managing the team of call agents and support them when required as the work here is highly challenging, especially now with the high number of calls every day.”

Daniyal Kiyani (20) is a newly recruited Helpline agent committed to helping people during the COVID-19 pandemic. ©UNICEF Pakistan/2020/Sharmin

All call agents undergo a comprehensive training on COVID-19 basic information and primary symptoms facilitated by the National Institute of Health, followed by sessions on the helpline technology and interpersonal communication.

“We generate a daily report and share with relevant sections and the helpline management team. This is very important as it helps us review and manage problems, to continue functioning as an efficient helpline supporting people in their time of need,” Huma explained.

With the leadership of the Government of Pakistan and the support of Global Polio Eradication Initiative (GPEI) partners – the United Nations Children’s Fund (UNICEF), World Health Organization (WHO) and Bill & Melinda Gates Foundation (BMGF), the Sehat Tahaffuz 1166 Helpline has become an essential support system for the people of Pakistan.

“GPEI partners are supporting the Government in utilizing existing polio eradication resources for the COVID-19 response in Pakistan. We are striving together to support as much as we can to ensure the health and safety of all children and families in the country during this challenging time,” said Dennis Chimenya, the UNICEF C4D team lead supporting the helpline in Pakistan.

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The COVID-19 pandemic response requires worldwide solidarity and an urgent global effort. The Global Polio Eradication Initiative (GPEI) stands ready to respond.

GPEI’s response to COVID-19 is driven by two principles. The first is our public health imperative to ensure that the polio programme fully plays its part in the COVID-19 response, supported by our second, underlying principle that when the emergency ends we will be ready to end polio with urgency and determination.

GPEI assets at service of COVID-19 response

The Polio Oversight Board (POB) has agreed that for the next four to six months, GPEI programmatic and operational assets and human resources, from global to country level, will be made available to enable a strong response to COVID-19, while maintaining critical polio functions, such as surveillance and global vaccine supply management.

GPEI will continue to deploy polio-funded personnel to the COVID-19 response and make available coordination mechanisms, such as emergency operations centers, and physical assets such as transportation or IT hardware. Through our extensive front-line worker networks in many countries, we will ensure the collection of information to provide evidence-informed guidance in line with WHO recommendations. At country level, the polio surveillance network is being trained on COVID-19 case detection, case and contact tracing, laboratory testing and data management. Our data management systems and front-line staff are already ramping up action in many countries, and wherever the polio programme has a presence we will continue to serve the response.

GPEI will also seek assurances that when GPEI staff is supporting COVID-19 front line activities, they will be provided with the necessary training, materials, equipment and logistics support to do so safely, in line with infection prevention and control measures. The GPEI is conscious that women, who make up most caregivers and health workers, are likely to bear a heavier burden as the pandemic plays out in polio-affected countries. Their health and safety are a priority and we are working on ways to mitigate impact including making sure that their voices are heard in management and leadership positions.

Pause in immunization campaigns

All countries planning to conduct poliovirus preventative campaigns are advised to temporarily postpone these campaigns until the second half of 2020. Countries which were planning to conduct poliovirus outbreak response campaigns are advised to postpone these campaigns until 1 June 2020 and then reevaluate based on the status of the COVID-19 pandemic.

The final decision to proceed with outbreak response rests with countries, who will need to evaluate the risks of a delayed response to detection of poliovirus against the risks of an immediate response, which could contribute to further spread of SARS-CoV-2 and more cases of COVID-19. Should an outbreak response campaign be pursued, countries should ensure measures needed to uphold infection prevention and control, protect health workers and safeguard the public are in place.

We take this decision with deep regret, knowing more children may be paralyzed by polio as a result. Nonetheless, GPEI believes it is the correct decision, given the imperative to save lives in the current emergency and not contribute to the further spread of COVID-19.

To mitigate the risks of lower immunity levels and to protect children from paralysis, GPEI will continue to work to the extent possible on strengthening essential immunization in the highest-risk areas for spread of poliovirus. This will be carried out under relevant WHO recommendations including the recommendation to prioritize vaccines for outbreak prone diseases such as polio, measles, diphtheria and yellow fever.

To more effectively meet communities’ health needs, the polio network will support delivery of basic services where it has the capacity to do so, including in Afghanistan, for example, through advocating for the establishment of health facilities in the most high-risk areas. We believe that the delivery of such basic services would contribute both to a successful COVID-19 response in these areas and to build trust and valuable engagement opportunities. As soon as it judged safe to do so, GPEI will support countries in conducting the appropriate catch-up vaccination campaigns.

Maintain surveillance

GPEI will place the highest priority on the continuation of poliovirus surveillance (acute flaccid paralysis and environmental) to closely monitor the circulation of wild and vaccine-derived polioviruses. GPEI will provide guidance and active support for countries on issues such as managing disruptions to shipping of stool samples, use of community surveillance and digital platforms and expanding environmental surveillance, where acute flaccid paralysis surveillance cannot be carried out.

Ready to end polio

GPEI will keep momentum on strategic areas to minimize loss of ground. We will ensure that we will come back stronger and faster when the COVID-19 emergency subsides, driven by our determination to achieve a polio-free world.

To prepare for this scale-up GPEI will work over the coming months to ensure the availability and readiness of polio vaccines with the goal of rapidly vaccinating at-risk communities as soon as the situation allows. Work will continue at full speed on the development and use of novel Oral Polio Vaccine type 2, with the aim of rolling out the new vaccine by the third quarter of 2020.

Over the coming months, continued partnership and support from donors and stakeholders will be critical to ensure GPEI continues driving progress toward polio eradication, given the likelihood that postponement of vaccination campaigns will lead to lengthened eradication timelines and increased resource needs. GPEI commits to keeping our donors and other stakeholders updated as the polio programme adjusts to the evolving COVID-19 global emergency.

Solidarity with the most vulnerable.

Eradication is about reaching the unreached and the most vulnerable. GPEI has been able to focus resources and strategies on how best to reach these communities, how to build trust and how to engage with them. These are also relevant challenges for implementing a successful COVID-19 response in the highest risk communities. All those working on and investing in a polio-free world should be proud of their contribution to the challenge of COVID-19. They are providing an important input into stronger health systems and global health security. They are supporting the ability of countries to prepare for and respond to emergencies, and ultimately to serve their most vulnerable.

Now, more than ever, is the time for solidarity and service above self.

Download the statement: English | French | Arabic | Spanish |

Policy statements

Urgent updated country and regional recommendations from the Polio Oversight Board – 26 May 2020
| English |

Use of bi-valent Oral Polio Vaccine supplied for polio Supplementary Immunization Activities in Routine Immunization activities | English | French |

Use of oral polio vaccine (OPV) to prevent SARS-CoV2 | English |

Safeguarding in-country mOPV2 stocks during COVID-19 pandemic pause | English |

Technical and operational guidance documents

Polio eradication programme continuity: implementation in the context of the COVID-19 pandemic | English | French |

Interim guidelines for frontline workers on safe implementation of house-to-house vaccination campaigns |English| French |

Interim guidance for the polio surveillance network in the context of coronavirus (COVID-19) | English |

This story is also available in other languages: French, German, Italian, Japanese, Korean, Portuguese and Spanish

Using the vast infrastructure developed to identify the poliovirus and deliver vaccination campaigns, the polio eradication programme is pitching in to protect the vulnerable from COVID-19, especially in polio-endemic countries. From Pakistan to Nigeria, the programme is drawing on years of experience fighting outbreaks to support governments as they respond to the new virus.

Pakistan

Few health programmes have as much practice tracking virus or reaching out to communities as the Pakistan polio eradication programme. This means the polio team is in a strong position to support the Government of Pakistan in COVID-19 preparedness and response.

Currently, the polio team is providing assistance across the entire country, with a special focus on strengthening surveillance and awareness raising. Working side-by-side with the Government of Pakistan, within three weeks the team has managed to train over 280 surveillance officers in COVID-19 surveillance. It has also supported the development of a new data system that’s fully integrated with existing data management system for polio. All polio surveillance staff are now doubling up and supporting disease surveillance for COVID-19. Through cascade trainings, they have sensitized over 6,260 health professionals on COVID-19, alongside their polio duties, in light of the national emergency. These efforts will continue unabated as the virus continues to spread.

Adding to the capacity of the government and WHO Emergency team, the polio team are also engaged in COVID-19 contact tracing and improving testing in six reference laboratories. They have been trained to support and supplement the current efforts, preparing for a sudden surge in cases and responding to the increase in travelers that need to be traced as a result of the rise in cases. The regional reference laboratory for polio in Islamabad is also providing technical support to COVID-19 testing and has been evolving to cater to the increased demands.

As this is a new disease, polio staff are lending their skills as health risk communicators – providing accurate information and listening to people’s concerns. The government of Pakistan extended a national help line originally used for polio-related calls to now cater to the public’s need for information on COVID-19. The help line was quickly adapted by the polio communication team once the first COVID-19 case was announced. The polio communications team is using strategies routinely used to promote polio vaccines to disseminate information about the COVID-19 virus, including working with Facebook, to ensure accurate information sharing, and airing television adverts. As time goes on, the teams will train more and more people ensuring the provision of positive health practices messages that can curb the transmission of the virus.

Afghanistan

Currently, community volunteers who work for the polio programme to report children with acute flaccid paralysis (AFP) are delivering messages on handwashing to reduce spread of COVID-19, in addition to polio. UNICEF is similarly using its Immunization Communication Network to disseminate information on personal hygiene.

Field staff have taken the initiative of using their routine visits to health facilities, during which they check for children with AFP, to check for and report people who may have COVID-19. Meanwhile, programme staff are building the capacity of health workers to respond to the novel coronavirus.

To coordinate approaches, the WHO Afghanistan polio team has a designated focal point connecting with the wider COVID-19 operation led by the Government of Afghanistan. The polio eradication teams at regional and provincial levels are working closely with the Ministry of Public Health, non-governmental organizations delivering Afghanistan’s Basic Package of Health Services and other partners to enhance Afghanistan’s preparedness.

Nigeria

“In the field, when there is an emergency, WHO’s first call for support to the state governments is the polio personnel,” says Fiona Braka, WHO polio team lead in Nigeria.

In Ogun and Lagos states, where two cases of COVID-19 have been detected, over 50 WHO polio programme medical staff are working flat out to mitigate further spread, using lessons learnt from their years battling the poliovirus. Staff are engaged in integrated disease surveillance, contact tracing, and data collection and analysis. Public health experts working for the Stop Transmission of Polio programme, supported by the US Centers for Disease Control and Prevention, are using their skills to undertake COVID-19 case investigations.

The WHO Field Offices -which are usually used for polio eradication coordination- are doubling up as coordination hubs for WHO teams supporting the COVID-19 response. The programme is also lending phones, vehicles and administrative support to the COVID-19 effort.

In states where no cases of COVID-19 have been reported, polio staff are supporting preparedness activities. At a local level, polio programme infrastructure is being used to strengthen disease surveillance. Polio staff are working closely with government counterparts and facilitating capacity building on COVID-19 response protocols and are working to build awareness of the virus in the community. Specials efforts are being undertaken to train frontline workers as they are at high risk of contagion.

Beyond polio-endemic countries

Trained specialists in the STOP program, part of the Global Polio Eradication Initiative, are actively supporting preparations or response to COVID-19 in 13 countries worldwide. The WHO Regional Office for Africa’s Rapid Response Team, who usually respond to polio outbreaks, are aiding COVID-19 preparedness in countries including Angola, Cameroon and the Central African Republic. Meanwhile, polio staff in other offices are ready to lend support, or are already lending support, to colleagues working to mitigate and respond to the new virus.

In our work to end polio, the programme sees the devastating impact that communicable diseases have. With this in mind, we are fully committed to supporting national health systems by engaging our expertise and assets to help mitigate and contain the COVID-19 pandemic, alongside continuing concerted efforts to eradicate polio.

For the latest information and advice on the COVID-19 disease outbreak visit the WHO website.

News Category: COVID-19

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