News Category: Vaccines

13 Novembre 2020 – Aujourd’hui, le programme de préqualification de l’Organisation mondiale de la Santé (OMS) a émis une recommandation d’autorisation d’utilisation d’urgence au titre du protocole EUL pour un nouveau vaccin antipoliomyélitique oral de type 2 (nVPO2). Le déploiement du vaccin sera ainsi autorisé pour une utilisation initiale limitée dans les pays touchés par des flambées de poliovirus circulant dérivé d’une souche vaccinale de type 2 (PVDVc2).

L’émission de cette recommandation au titre du protocole EUL pour le nVPO2 vient au terme de plusieurs mois d’analyse rigoureuse des données issues d’essais cliniques qui ont démontré l’innocuité du vaccin et une protection contre la poliomyélite comparable à celle fournie par le VPO monovalent de type 2 (VPOm2) actuellement utilisé.

Le nVPO2 est une version modifiée du VPOm2, mis au point depuis près de dix ans grâce à la collaboration d’un vaste réseau d’experts mondiaux.[1] Outre son innocuité et son efficacité, les essais cliniques montrent que ce vaccin est génétiquement plus stable que le VPOm2, ce qui réduit nettement la probabilité qu’il retrouve une forme pouvant entraîner une paralysie dans les milieux présentant un faible niveau d’immunité. Par conséquent, le nVPO2 réduit le risque de voir apparaître de nouvelles flambées de PVDVc2, même si le VPOm2 demeure un vaccin sûr et efficace qui protège contre la poliomyélite et qui a permis d’empêcher des flambées de PVDVc2 par le passé.

Qu’est qu’une autorisation d’utilisation d’urgence ?

La procédure EUL de l’OMS, anciennement connue sous le nom de procédure d’évaluation et d’homologation en situation d’urgence de l’OMS (Emergency Use Listing, EUL), a été créée pour évaluer et répertorier les nouveaux vaccins, traitements et produits diagnostiques qui ne sont pas encore homologués afin qu’ils puissent être utilisés de façon précoce et ciblée en réponse à une urgence de santé publique de portée internationale (USPPI).

 Ce mécanisme a déjà été utilisé avec succès pour accélérer la mise à disposition de produits diagnostiques pour les virus Ebola et Zika et, fin septembre, une autorisation d’utilisation d’urgence au titre du protocole EUL a été émise pour un test de diagnostic rapide de l’antigène de la COVID-19 qui donne des résultats en 30 minutes.

 Pour qu’un produit reçoive une recommandation d’utilisation au titre du protocole EUL, l’OMS et des experts indépendants examinent les données cliniques existantes afin de déterminer son innocuité, sa qualité et son efficacité, et la décision d’émettre une recommandation est fondée sur une évaluation approfondie des avantages et des risques au vu de l’urgence de santé publique.

Pendant toute la durée d’utilisation d’un produit au titre du protocole EUL, on continue à recueillir des données et à les suivre de près afin de déterminer si ce produit peut recevoir une autorisation d’utilisation d’urgence au titre du protocole EUL.

Pourquoi le protocole EUL est-il utilisé pour le nVPO2 ?

Compte tenu des situations d’urgence actuelles concernant le PVDVc2 en Afrique et en Asie et du fait que la poliomyélite est considérée depuis 2014 comme une urgence de santé publique de portée internationale (USPPI), au mois de février, le Conseil exécutif de l’OMS a prié instamment les États Membres d’accélérer les procédures d’autorisation de l’importation et de l’utilisation du nVPO2 au titre du protocole EUL au vu des résultats prometteurs de ce vaccin dans la lutte contre le PVDVc2.

Les flambées de PVDVc2 se produisent lorsque la souche affaiblie du poliovirus contenue dans le vaccin antipoliomyélitique oral (VPO) peut se propager au sein de populations sous-vaccinées pendant une période prolongée et retrouver une forme pouvant entraîner une paralysie. L’année dernière, il y a eu 366 cas de PVDVc2 dans le monde. Au cours des dix premiers mois de 2020, on a recensé 588 cas (données au 28 octobre 2020).

Outre la décision du Conseil exécutif, le Groupe stratégique consultatif d’experts (SAGE) sur la vaccination a approuvé dans son principe un cadre définissant les critères d’une utilisation initiale pour permettre le déploiement rapide et ciblé du nVPO2. À la suite de sa réunion du 5 au 7 octobre, le SAGE a également approuvé, sur le principe, que le nVPO2 devienne le vaccin de choix pour lutter contre les flambées de PVDVc2, une fois que l’examen de la période initiale d’utilisation sera terminé et que toutes les conditions d’utilisation de ce nouveau vaccin seront remplies.

Des études cliniques sur le nVPO2, menées en Belgique et au Panama, ont montré que le vaccin était sûr et efficace pour protéger contre la poliomyélite, et qu’il présentait moins de risque de retrouver une forme pouvant entraîner une paralysie dans des populations sous-vaccinées.

Au cours des six derniers mois, le programme de préqualification de l’OMS a minutieusement analysé les données émanant de ces études afin de déterminer si le nVPO2 répondait aux exigences du protocole EUL. Grâce à la recommandation au titre de ce protocole, le nVPO2 constitue désormais un moyen supplémentaire de la Stratégie de lutte contre le PVDVc2 de l’IMEP.

Quelle est la période d’utilisation initiale du nVPO2 ?

Comme le précise le cadre approuvé par le SAGE, la période d’utilisation initiale durera environ trois mois après la première utilisation du nVPO2 au titre du protocole EUL, et ce vaccin sera déployé de manière mesurée dans la lutte contre les flambées de PVDVc2.

L’IMEP travaille étroitement avec les pays touchés par des flambées de PVDVc2 afin de déterminer où le nVPO2 peut être utilisé pendant la période initiale. Cette décision s’appuiera notamment sur la situation épidémiologique actuelle et sur la capacité du pays à mener la surveillance renforcée requise en termes d’innocuité et d’efficacité du nVPO2 pendant son déploiement.

 Il est important de noter que toute décision d’utiliser le nVPO2 sera prise par le pays et soumise à l’accord des responsables concernés dans le pays et des autorités de réglementation nationales. Le VPOm2 restera disponible pour faire face aux flambées dans les pays qui ne répondent pas aux critères d’une utilisation initiale ou qui décident de ne pas utiliser le nVPO2 initialement.

 L’utilisation initiale du nVPO2 devrait avoir lieu environ cinq à huit semaines après la publication de la recommandation d’utilisation au titre du protocole EUL, en tenant compte des processus réglementaires et des approbations définitifs, de l’achat des vaccins, de l’expédition et de l’état de préparation du pays. L’IMEP continue de travailler en étroite collaboration avec les pays à haut risque, en les aidant à se préparer à utiliser le nVPO2.

Perspectives d’avenir

On continuera à recueillir des données sur le nVPO2 pendant la période d’utilisation initiale, en plus des études en cours et de celles qui seront menées prochainement.

Parallèlement à l’utilisation initiale du nVPO2, l’IMEP poursuivra la mise en œuvre des autres volets de sa stratégie globale de lutte contre les flambées de PVDVc2. Cette stratégie consiste notamment à optimiser la riposte aux flambées en utilisant le VPOm2, à renforcer la vaccination systématique avec le vaccin antipoliomyélitique inactivé dans les zones à haut risque et à veiller à ce que les stocks de VPO soient suffisants pour que chaque enfant puisse en bénéficier.

En savoir plus sur le développement de nVPO2

[1] Le nVPO2 a été mis au point grâce à un partenariat mondial réunissant de multiples agences et experts internes et externes à l’Initiative mondiale pour l’éradication de la poliomyélite (IMEP). Il s’agit notamment de Bio Farma, de l’Université d’Anvers, de la FIDEC (Fighting Infectious Diseases in Emerging Countries), du NIBSC (National Institute for Biological Standards and Control), de l’UCSF (University of California San Francisco), des CDC (Centers for Disease Control and Prevention des États-Unis), de PATH et de la Fondation Bill et Melinda Gates.

Version française

13 November 2020 – Today, the World Health Organization’s (WHO) Prequalification (PQ) program issued an Emergency Use Listing (EUL) recommendation for the type 2 novel oral polio vaccine (nOPV2). This will allow rollout of the vaccine for limited initial use in countries affected by circulating vaccine-derived poliovirus type 2 (cVDPV2) outbreaks.

The PQ program’s issuance of an EUL recommendation for nOPV2 follows months of rigorous analysis of existing data from clinical trials of the vaccine, that have shown it to be safe and provide comparable protection against polio as the currently used type 2 monovalent OPV (mOPV2).

nOPV2 is a modified version of mOPV2 and has been in development for close to a decade thanks to the collaboration of an extensive network of global experts.[1] In addition to nOPV2’s safety and efficacy, clinical trials show the vaccine to be more genetically stable than mOPV2, making it significantly less likely to revert into a form which can cause paralysis in low immunity settings. This means a reduced risk of seeding new cVDPV2 outbreaks compared to mOPV2, which remains a safe and effective vaccine that protects against polio and has successfully stopped cVDPV2 outbreaks in the past.

What is an Emergency Use Listing?

The WHO’s EUL procedure, previously known as the Emergency Use Assessment and Listing (EUAL) procedure, was created to assess and list new and yet-to-be licensed vaccines, therapeutics and diagnostics to enable their early, targeted use in response to a Public Health Emergency of International Concern (PHEIC).

This mechanism has previously been used to successfully accelerate the availability of diagnostic products for Ebola and Zika virus, and in late September, EUL was issued for an antigen rapid diagnostic test for COVID-19 that provides results within 30 minutes.

For a product to receive an EUL recommendation, existing clinical data is scrutinized by WHO and independent experts to determine its safety, quality and efficacy, and a decision to list is based on a thorough benefit-risk assessment considering the public health emergency.

Throughout a product’s use under EUL, data continues to be collected and closely monitored to help inform decisions about whether the emergency listing can be maintained.

Why is EUL being used for nOPV2?

In light of ongoing cVDPV2 emergencies across countries in Africa and Asia, coupled with polio’s status as a Public Health Emergency of International Concern (PHEIC) since 2014, the WHO Executive Board urged Member States in February to expedite the processes for authorizing the importation and use of nOPV2 under the EUL given data showing the vaccine’s promise against cVDPV2s.

cVDPV2 outbreaks occur when the weakened poliovirus strain contained in the oral polio vaccine (OPV) is able to spread among under-immunized populations for a prolonged period and reverts to a form that can cause paralysis. Last year, there were 366 cases of cVDPV2 globally, while in the first 10 months of 2020 alone there have been 588 cases (data as of 28 October 2020).

In addition to the Executive Board decision, the Strategic Advisory Group of Experts (SAGE) on Immunization endorsed in principle an initial use criteria framework to support early, targeted nOPV2 rollout. Following its 5-7 October meeting, SAGE also endorsed, in principle, that nOPV2 become the vaccine of choice in response to cVDPV2 outbreaks after review of the initial use period is completed and all requirements for nOPV2’s use are met.

Clinical studies on nOPV2, conducted in Belgium and Panama, have shown the vaccine to be safe and efficacious in protecting against polio, while carrying less risk of reverting into a form that can cause paralysis in under-immunized populations.

Data from these studies has been subject to WHO PQ program’s rigorous analysis for the past six months to determine if nOPV2 meets requirements for EUL. The EUL recommendation means nOPV2 is now an additional tool in the GPEI’s Strategy for Control of cVDPV2.

What is the initial use period for nOPV2?

The initial use period, as detailed in the SAGE-endorsed framework, will last for approximately three months following the first use of nOPV2 under EUL and will see nOPV2 deployed in a measured way to tackle ongoing outbreaks of cVDPV2.

The GPEI is working closely with countries affected by cVDPV2 outbreaks to determine where nOPV2 can be used during the initial period. Factors that will inform this decision include the current epidemiology and the country’s ability to conduct the required enhanced monitoring of nOPV2’s safety and effectiveness during rollout.

Importantly, any decision to use nOPV2 will be country-led and subject to agreement from relevant in-country officials and national regulatory authorities. mOPV2 will remain available for outbreak response in countries that do not meet initial use criteria or choose not to use nOPV2 initially.

It is anticipated that the initial use of nOPV2 will take place approximately five to eight weeks after the EUL recommendation issues, factoring in final regulatory processes and approvals, vaccine procurement, shipping and country readiness. GPEI continues to work closely with high-risk countries, supporting with preparations to use nOPV2.

Looking ahead

Data on nOPV2 will continue to be collected during the initial use period, in addition to further nOPV2 studies that are underway and will be conducted in the near future.

Alongside nOPV2’s initial use, the GPEI will continue to implement the other strands of its comprehensive strategy to control cVDPV2 outbreaks. This includes optimizing outbreak response using mOPV2, strengthening routine immunization with inactivated polio vaccine in high-risk areas, and ensuring adequate supplies of OPV are available to reach every child.

Read more on nOPV2 development

[1] A global partnership across multiple agencies and experts from within and outside of GPEI have supported nOPV2’s development. This includes Bio Farma, University of Antwerp, Fighting Infectious Diseases in Emerging Countries (FIDEC), National Institute for Biological Standards and Control (NIBSC), University of California San Francisco (UCSF), US Centers for Disease Control and Prevention (CDC), PATH, the Bill & Melinda Gates Foundation, and several others.

 

Dedicated to all polio survivors!

You were young?

An infant

perhaps,

or even an adult;

weak

and torn from life

with a limbless feeling.

Stretched out,

almost motionless

and helpless,

you were lying

in a hospital bed

without even a pillow,

isolated

from the outside world.

A period

of lonely days, weeks,

and frightening nights;

left with your own day-dreams

and nightmares;

an unconscious presence

with no vision of the

future outcome.

Despite the ups and downs

of rehabilitation efforts,

a different world

awaited you

on the day you left.

In this other world,

even after recovery,

an everlasting trace remained,

a stain,

with which you were forced

to live with and accept.

This stain;

a remnant influential trace;

became a life’s companion.

Inwardly and

invisible to the outside;

you had become

an idiosyncratic person

quite often miss-understood.

Constantly left

to self-decision making,

with countless setbacks;

you had to make

it on your own.

Normality

required more strength

that you just didn’t have any more.

Nobody else saw it that way,

other than yourself.

Sometimes,

on the verge of hopelessness,

thoughts of an end

to your misery

may have come to mind.

You have lived your life

on the threshold

of limits

to your reserves.

Now,

many years,

possibly decades later,

you face the consequences,

the big bill!

Sadly, you pay it

with the loss of life’s quality,

living with the discrepancy

between wanting to

and not being able to.

I bow in humility

to your life’s achievements,

as I too have walked

along this path.

Modified lyrical translation: German to English by Tom House

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.

Related resources

Pakistan polio snapshot - February 2020
Polio eradication and COVID-19

In Karachi’s Gadap Town, many families lack basic health and municipal services. To fill the gap, the Polio Emergency Operations Centre in Pakistan’s Sindh province has recently renovated an abandoned hospital to create an Emergency Response Unit (ERU). The unit provides polio vaccination to communities alongside PolioPlus activities to improve overall health. The unit was built with the support of Rotary International, WHO, UNICEF and the Bill & Melinda Gates Foundation.

Click through the gallery to see how the Gadap Emergency Response Unit has changed health delivery:

Image
©WHO Pakistan/Dawood Batozai

Gadap Town is home to many informal doctors who are not sufficiently trained to provide basic health services to the community. Often, they put their patients at risk. Before the creation of the Emergency Response Unit (ERU), most people had no choice but to rely on them for basic healthcare.

Image
©WHO Pakistan/Dawood Batozai

Now, the PolioPlus programme has helped turn the once abandoned Jannat Gul Hospital into a vibrant health centre. The hospital was renovated in record time and was inaugurated by the Minister of Health for Sindh Dr. Azra Fazal Pechuho, EOC Coordinator Mr. Umer Farooq Bullo and Rotary Pakistan PolioPlus Committee Chair Mr. Aziz Memon.

Image
©WHO Pakistan/Dawood Batozai

The new ERU hosts essential immunization services for children, including polio vaccination. The site also houses equipment to keep vaccines cold and ready for use.

Image
©WHO Pakistan/Dawood Batozai

Outside, a lawn with play equipment has been set up. Gadap is one of Pakistan’s largest slums, and the provision of a rare child-friendly environment as part of the health facility is helping to build community trust and acceptance of the polio eradication programme.

Image
©WHO Pakistan/Dawood Batozai

One room is for use by children suffering Acute Flaccid Paralysis and is also used to monitor any child having a reaction to immunization. The room is managed by a Government Medical Officer, supported by WHO provincial and federal monitors during polio vaccination campaigns.

Image
©WHO Pakistan/Dawood Batozai

A multipurpose room is used for trainings and planning before and during polio vaccination campaigns.

The ERU also hosts a data support centre that allows staff to relay live updates on polio campaign performance to the Sindh Emergency Operations Centre.

Image
©WHO Pakistan/Dawood Batozai

Five health dispensaries have been set up Gadap Town as part of the project, whilst a local Maternity Home is also being renovated.
These facilities will improve essential immunization and provide basic primary health services. They will also provide gynecological and maternal health services, which are in extremely high demand in Gadap.

Image
©WHO Pakistan/Dawood Batozai

The Government envisages that the ERU will continue to provide vital health services to families long after polio is eradicated. Rather than resorting to the care of informal doctors and nurses, the community can now access better quality healthcare, funded by the public sector.

From an abandoned hospital to a successful community health project: This is what the ‘plus’ in PolioPlus looks like.

 

Nigeria has been free of wild poliovirus for three years thanks to hardworking health workers and parents. © WHO
Nigeria has been free of wild poliovirus for three years thanks to hardworking health workers and parents. © WHO

21 August  2019 marks three years since Nigeria last reported a case of wild poliovirus. This is an important public health milestone for the country and the entire Africa Region, which is now a step now closer to polio-free certification.

At the press conference in Abuja, the Executive Director of the National Primary Health Care Development Agency (NPHCDA), Dr Faisal Shuaib, acknowledged that the three-year mark is an important moment in the fight against polio but also emphasized the need for vigilance  ̶ “one which we must delicately manage with cautious euphoria.”

“This achievement would certainly not have been possible without the novel strategies adopted in the consistent fight against polio and other vaccine preventable diseases. We commend the strong domestic and global financing and the commitment of government at all levels,” the Executive Director stated.

Innovation, partnership and resolve have all underpinned advancements made in Nigeria, together with the commitment of tens of thousands of health workers. “Since the last outbreak of wild polio in 2016 in the northeast, Nigeria has strengthened supplementary immunization activities and routine immunization, implemented innovative strategies to vaccinate hard-to-reach children and improved acute flaccid paralysis (AFP) and environmental surveillance. These efforts are all highly commendable,” said WHO’s Officer in Charge for Nigeria, Dr Peter Clement.

However, despite progress, there is still much left to be done. Continued work to reach every last child with the polio vaccine, as well as strengthening surveillance and routine immunization across the region, will be key to keeping wild polio at bay and protecting the gains achieved.

Should there be no more cases in Nigeria or from countries in the Africa Region, and surveillance data submitted by countries meets evaluation criteria, the Africa Regional Certification Committee (ARCC) could certify the Region as wild polio-free as early as mid-2020.

The press briefing was attended by country representatives of all GPEI partners: WHO, UNICEF, CDC, Rotary and the Bill & Melinda Gates Foundation; as well as USAID, Government of Germany, EU and Canada. The Emir of Jiwa, representing the Northern Traditional Leaders Committee was also in attendance.

Read the press release.

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.

Construction of the Poliopolis “container park” in Antwerp. © University of Antwerp
Construction of the Poliopolis “container park” in Antwerp. © University of Antwerp

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.

The interior of a study participant's room in Poliopolis. © University of Antwerp
The interior of a study participant’s room in Poliopolis. © University of Antwerp

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.

Related resources

US Centers for Disease Control and Prevention – Welcome to Poliopolis
Marking the finger with indelible ink, an-all important part of the polio immunization activity. ©WHO/Nigeria
Marking the finger with indelible ink, an-all important part of the polio immunization activity. ©WHO/Nigeria

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

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

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

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

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

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

A young child receiving polio vaccination. ©WHO/Nigeria
A young child receiving polio vaccination. ©WHO/Nigeria

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.

Related resources

A vaccine for every baby
Religious leaders fueling demand for polio vaccines and health services in Nigeria
Disease surveillance innovation help defeat the poliovirus

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

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

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

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

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©S. Kashif
Farwa holding her baby while the vaccinator prepares an injectable vaccine

Farwa—Mother, Rawalpindi, Punjab province
“There is no question about getting him (son) vaccinated because everyone in our community does so. All our children are precious to us, so we encourage each other to follow the immunization schedule.”
“It is our duty as parents to make sure our children are given preventative treatment from a young age so that they do not fall prey to deadly diseases.”

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©S. Kashif
Grandmother holding her grandson after vaccination

Grandmother—Rawalpindi, Punjab province
“I always bring my grandson to the door when community vaccinators come, or I take him to the local health centre. I am usually the one at home with him during the day, so it is my responsibility to ensure he gets his vaccinations. I do this because I know it is necessary to provide him this protection in childhood – before, God forbid – anything bad happens to him.”

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©S. Khan
Shazia with her daughter Aasia after visiting vaccination

Shazia—Mother, Rawalpindi, Punjab province
“My daughter Aasia is only nine months old and I make sure to bring her for all her necessary vaccinations and check-ups. I make sure she is vaccinated because it will help give her the best life possible and ensure she grows up happy, healthy and safe.
“As a mother, nothing in the world makes me happier than knowing this!”

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©S. Kashif
Rijha and her doll posing in front of a mirror

Tajarya Najam Ghulam—Aunt, Rawalpindi, Punjab province
“My niece Rijha is two years old. She loves playing with her precious doll. Every time vaccinators come to our door, I tell her that she and her doll must rush downstairs to get vaccinated or else they will get sick. When she hears this, she never protests and runs downstairs to get vaccinated with the other children on our street!”

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©A. Khan
Toddler Jannat playing with her doll after vaccination

Jannat Awais—Lahore, Punjab province
“I took drops because mother says they keep me safe from diseases and I don’t like being sick. When I am sick I cannot play with my cousins and my mother and father take me to the doctor. I like to dress up as a princess, because they are beautiful and also healthy. The drops tasted very bad, but I still took them because my teacher at the school said we have to. She also told me that they keep me and my friends safe from diseases.”

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©W. Abbas
Mufti Laeeq in his library

Mufti Laeeq Ahmad Ghaznavi—religious scholar, Peshawar, Khyber Pakhtunkhwa province
“I am often asked what Islam says on the usage of vaccines and whether they are permissible. People have seen so much controversy on immunization in newspapers and on audio/visual channels, so they are seeking a clear answer. I present evidence and analysis from scientists, religious scholars and doctors to tell them that vaccines are beneficial. I am very hopeful that after we provide them with logical reasoning and the correct teachings regarding immunization, people leave convinced and satisfied that they can continue to use vaccinations without any apprehensions.”

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©S. Gull
Gulbashra marking the door of a house with her mother-in-law supporting her

“My mother-in-law often helps me out. She has very good communication skills despite being illiterate, and while I vaccinate children she engages the mothers and even men, if they are home, when there is a refusal. After struggling over the last three years, our community now accepts vaccination and we are mobilizing them for routine immunization.
“I enjoy my work. It gives me a chance to work for my own people and to support my extended family. Health education is critical for all individuals living in a community. These two drops to each child in every polio campaign is the only solution to eliminate polio from world.”

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©A. Khan
Sajjad visiting houses to vaccinate children

Muhammad Sajjad—Vaccinator, Lahore, Punjab province
“Vaccination should be mandatory for all children as it saves them from several deadly diseases. As time passes, people are becoming more aware of this. Parents are now taking their children to the health facilities for vaccination. And after just one mosque announcement, mothers bring their children to the RI (routine immunization) station for vaccination.”

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©A. Khan
Aliya administering polio drops to child during

Aliya Shabnum—Lady health worker, Lahore, Punjab province
“I have worked for polio eradication in Pakistan for 25 years now. I have seen the change the reduction in polio cases first-hand. I am confident that Pakistan will become polio-free soon. My biggest motivation for this job is time. I have invested so much of my life’s work in the field vaccinating children. I cannot quit now. I have to see the end.”

Related resources

Pakistani women march ahead in the fight against polio
Joining hands across the border

Reposted with permission from Rotary.org

Ready for a long day—vaccines are put in cold boxes as a part of the cold chain to reach as many children as possible in the door-to-door vaccination campaigns. © Rotary International.
Ready for a long day—vaccines are put in cold boxes as a part of the cold chain to reach as many children as possible in the door-to-door vaccination campaigns. © Rotary International.

From the epidemics in the 1950s to the 1000 cases per day in the 1980s, polio’s devastation has seeped across generations. That is, until Global Polio Eradication Initiative and anchoring partners, Rotary International, WHO, UNICEF, CDC, and most recently, the Bill & Melinda Gates Foundation, united efforts and resources to develop a comprehensive polio eradication infrastructure.

Ranging from cutting edge research to dedicated laboratories to community engagement to sewage sampling, the polio infrastructure is as widespread as it is comprehensive. With presence in over 200 countries, the polio programme is second to none, making it one of the largest public-private health partnerships in history.

While the polio eradication infrastructure helps get us closer to a polio-free world, did you know that it is also used to fight and protect against other diseases, too? Here are five examples of the polio infrastructure at work:

The cold chain 

The Oral Polio Vaccine (OPV) requires constant refrigeration and vaccine must be kept cool between 2-8 degrees, or it risks losing its effectiveness. This is no easy task in countries and areas where electricity is either unavailable or unreliable.

So, the programme developed what is known as a cold chain system — made up of freezers, refrigerators, and cold boxes — to allow polio workers to store the vaccine and transport it over long distances in extremely hot weather. In Pakistan, a measles immunization program now relies on the same system. With the help of the cold chain, Sindh province recently reached its goal of immunizing more than 7.3 million children against measles.

One of the biggest successes of the polio programme has been the ability to reach every last child, in part due to microplanning. ©WHO
One of the biggest successes of the polio programme has been the ability to reach every last child, in part due to microplanning. ©WHO

Microplanning

A critical component in immunizing more children against polio, especially in remote regions, is microplanning. A microplan allows health workers to identify priority communities, address potential barriers, and develop a plan for a successful immunization campaigns.

The workers collect as many details as possible to help them reach and vaccinate all the children. This strategy has helped keep India polio-free for five years. Now the Mewat district of India is using microplanning to increase its rates of vaccination against measles and rubella.

Surveillance

The polio surveillance system helps detect new cases of polio and determines where and how these cases originated. Environmental surveillance, which involves testing sewage or other environmental samples for the presence of poliovirus, helps workers confirm polio cases in the absence of symptoms like acute flaccid paralysis (AFP).

In Borno state in Nigeria, the AFP surveillance system is now being used to find people with symptoms of yellow fever and was one of many tactics used during a 2018 yellow fever outbreak that resulted in the vaccination of 8 million people.

Contact tracing

Since polio is a transmittable disease, health workers use contact tracing to learn who has come in contact with people who might be infected. Contact tracing was also critical to containing an Ebola outbreak in Nigeria in 2014. When a traveller from Liberia was diagnosed with Ebola, Nigerian officials were able to quickly trace and isolate the traveller’s contacts, helping prevent the disease from spreading further.

The polio programme is meticulous in making sure we reach every child in every corner of the world. ©WHO/Chad
The polio programme is meticulous in making sure we reach every child in every corner of the world. ©WHO/Chad

Emergency operations centres

An important part of the polio infrastructure that Rotary and its partners have built is the emergency operations centres network. These centres provide a centralized location where health workers and government officials can work collaboratively and generate a faster, more effective emergency response. The emergency operations centre in Lagos, Nigeria, which was originally set up to address polio, was adapted to handle Ebola, and it ultimately helped the country respond quickly to an Ebola outbreak. Only 19 Ebola cases were reported, and the country was declared Ebola-free within three months.

Related resources

The Microplanning Puzzle: Planning for an Effective Vaccination Campaign
The Future of Disease Surveillance—Rolling out innovation in real-time tracking network across Africa
Pakistan’s polio fighters lend a hand in the battle against measles

The Global Polio Eradication Initiative in collaboration with Gavi, The Vaccine Alliance, has successfully achieved the global goal, set in 2013, of 126 Oral Polio Vaccine (OPV)-using countries incorporating at least one dose of IPV in their immunization activities. The last two remaining countries, Mongolia and Zimbabwe, introduced IPV in their immunization programmes in April 2019.

Read more.

Mothers waiting to have their children vaccinated. © WHO AFRO
Mothers waiting to have their children vaccinated. © WHO AFRO

A new circulating vaccine-derived poliovirus type 2 (cVDPV2) outbreak has been confirmed in Mozambique. Two genetically-linked circulating vaccine-derived poliovirus type 2 (cVDPV2) isolates were detected from an acute flaccid paralysis (AFP) case (with an onset of paralysis on 21 October 2018, in a six-year old girl with no history of vaccination, from Molumbo district, Zambézia province), and a community contact of the case.

As polio is a highly infectious disease which transmits rapidly, there is potential for the outbreak to spread to other children across the country, or even into neighbouring countries, unless swift action is taken. Global Polio Eradication Initiative and partners are working with country counterparts to support the local public health authorities in conducting a field investigation (clinical, epidemiological and immunological) and thorough risk assessment to discuss planning and implementation of immunization and outbreak response.

In January 2017, a single VDPV2 virus had been isolated from a 5-year old boy with AFP, also from Zambézia province. Outbreak response was conducted in the first half of 2017 with monovalent oral polio vaccine type 2 (mOPV2).

Read our Mozambique country page to see information on cases, surveillance and response to the developing outbreak.

Related resources

Vaccine-derived polioviruses
Responding to a polio outbreak
© GPEI

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.

Joint statement by of the main, independent, advisory and oversight committees of the GPEI
Response to the statement by WHO Director-General and Chair of Polio Oversight Board Dr Tedros Ghebreyesus
A nomad child is vaccinated against polio in Lower Juba, Somalia.
A nomad child is vaccinated against polio in Lower Juba, Somalia. © WHO/EMRO

Since polio was confirmed in Somalia in late 2017, health authorities have led a complex response to twin outbreaks of circulating vaccine-derived poliovirus type 2 and type 3 (cVDPV2 and cVDPV3), paying special attention to high-risk populations: nomads, internally displaced people (IDPs), and people living in peri-urban slums and rural areas.

So far, five of Somalia’s 12 infected children are from nomadic communities, and another four are from internally displaced families living in urban areas. To boost immunization among eligible children in these populations, vaccination activities have placed a special focus on reaching these communities.

Somalia has a rich culture of people leading pastoral lifestyles, raising livestock and moving with them as the seasons and the weather change. Nomadism has a long history in Somalia and nomads have a special place in Somali society: almost a third of Somalia’s people are nomads. However, they do not observe formal international borders – just like the poliovirus.  For health workers, this context poses a significant challenge: How can you be sure you have vaccinated every last child when so many children are on the move?

For health workers, this means searching for polio symptoms in more than 900 health facilities across the country, as well as nutritional centres, camps for  IDPs, and key sites along Somalia’s borders. At transit points, along borders and at water collection points, polio teams work to vaccinate children moving in and out of areas experiencing conflict or with limited access to health services. In high-risk areas, the Somali Government, WHO and UNICEF hire local vaccinators – people known and trusted by their communities – and when additional security is necessary, polio partners provide it.

Gaining high-level political goodwill

Even in an emergency, cross-border collaboration is not always easy to come by. In the Horn of Africa outbreak, regional collaboration moved into high gear in September, when health ministers from across the region and representatives from the Intergovernmental Authority on Development (IGAD) countries came together in the Kenyan town of Garissa to reiterate their commitment to ending polio.

One of the event’s key messages was around the risks posed by the easy and frequent mobility of communities across borders. Kenya’s national polio immunization ambassador, former UN Person of the Year and polio survivor, Harold Kipchumba, spoke directly to the pastoral communities in the region.

Kipchumba highlighted their focus on vaccinating animals, and urged parents in these communities to use the same vigour to vaccinate their children against polio, so they are able to serve as future herders for their families.

A regional response to support high-risk populations

The Technical Advisory Group, an independent body of experts that monitors outbreaks and offers guidance, recommended that countries in the region strengthen their coordination. In response, the Horn of Africa Coordination Unit coordinates joint responses among HoA countries – work that includes monitoring current outbreaks, and collaboratively planning, mapping, conducting immunization campaigns and communicating with various audiences. This ensures that countries work together in partnership rather than in silos, viewing the outbreak as one epidemiological block.

At regional and district levels, teams have spent the last few months building records of every settlement in their area, by lifestyle (nomad, IDP, peri-urban slums, rural). The highest priority: locating special populations – internally displaced persons, refugees, nomadic families, people living in informal settlements in urban areas and communities living in access-compromised areas – in order to reach them with vital polio vaccine.

Vaccinators at work in a camp for internally displaced people (IDPs). © UNICEF/Somalia
Vaccinators at work in a camp for internally displaced people (IDPs). © UNICEF/Somalia

Using technology to reach more children

A vital step in reaching more children, particularly those on the move, has been to move away from paper records and use electronic tools to collect data on children reached and missed during campaigns. This gives data specialists and decision-makers timely, accurate information, allowing them to analyze data in real time and flag areas with where high numbers of children are missed, so teams can revisit these households the following day.

Getting vaccines to the doorstep is not the only challenge for polio eradication teams in Somalia. Parents and caregivers also need information to ensure their children are vaccinated – something Kipchumba spoke to. On rare occasions, vaccinators meet families unconvinced of the need for vaccinations, particularly when the family has a newborn child or a sick child. In the lead up to every campaign, teams of social mobilizers, sometimes joined by influential Islamic leaders or scholars, visit communities to alert them of dates of polio immunization campaigns and the benefits of vaccination. Here, too, special attention is paid to nomadic communities, as polio teams liaise with elders from these communities in order to learn more about these communities and their needs, and to inform community members in appropriate ways about immunization dates and benefits of vaccination.

Related Resources

Vaccination in Somalia: “It’s my job”
Somalia celebrated 3 years polio free: WHO urges continued caution
“Nothing is impossible”: gaining ground on polio in the Horn of Africa

In the last week of October, Djibouti’s Ministry of Health, working with WHO, UNICEF and other partners, successfully carried out the country’s first polio National Immunization Days (NIDs) since 2015.

A child being vaccinated at the NID launch in Djibouti. WHO/Djibouti
A child being vaccinated at the NID launch in Djibouti. © WHO/Djibouti

While Djibouti has not had a case of polio since 1999, the recent outbreaks of polio in neighbouring countries in the Horn of Africa, and the low levels of routine immunization coverage in some areas in the country, are indications that Djibouti is still at risk if poliovirus spreads through population movements. Other countries in the Horn of Africa are already cooperating to stop the ongoing outbreak and to reduce the risk of spread, and especially considering that Djibouti is on a major migration route in the Horn of Africa, it makes a lot of sense for Djibouti to join in this coordinated response.

For Dr Ahmed Zouiten, the acting WHO Representative (WR) in Djibouti, this context demanded action.

“I prefer to deal with a campaign for prevention than to have to deal with an outbreak of polio,” he said.

With that in mind, an NID planned for 2019 was brought forward and carried out over 23-26 October. The target was 120 000 children under five years of age, a number suggested by Djibouti’s last census, in 2009. Two strategies were proposed: one approach, where children would be vaccinated at fixed points (health facilities) and a complementary door-to-door approach using two-person teams (a vaccinator and a registration person).

In the days and weeks before the NID, all partners, including the government, WHO and UNICEF, used a variety of communication channels – from outdoor signage to radio spots – to ensure that communities were informed not just of the risks of polio, but also of the importance of protecting children from vaccine preventable diseases.

A mother and her child at the launch of the Djibouti NID. WHO/Djibouti
A mother and her child at the launch of the Djibouti NID. © WHO/Djibouti

The campaign’s official launch ceremony was held at the Youssouf Abdillahi Iftini Polyclinic in Balbala neighborhood, Djibouti City, in the presence of Djibouti’s Minister of Health, WHO and UNICEF representatives, and other partners. Over the course of the following days, vaccinators surpassed targets, vaccinating all children under five they encountered living on Djibouti territory, regardless of their origin, including nomadic populations, refugees and migrant children.

Although final numbers are still being tabulated through independent monitoring mechanisms, initial results suggest high coverage of the target population. This means vaccinators reached the estimated target number of children, and more, such as newer cohorts of children not accounted for in earlier estimates. Catching these children helps to further inform immunization estimates for any further campaigns.

For Dr Zouiten, a result like this is something to celebrate.

“Today, our children are on their way to being better protected, and we are launching a second campaign in the near future to follow up on that,” he said.

“Before, we had some worries; we thought that the circulation of poliovirus in the region posed a risk. Now with this first vaccination campaign, we know we are on the right path to ensure the children of Djibouti are protected. These results weren’t easy to achieve, but were made possible through collaboration between the Ministry of Health, the partnership between WHO, UNICEF and others.”

Given the high risk of importation of poliovirus, the Government of Djibouti, WHO and UNICEF are not taking any chances: plans are in the works for a second and third NID to roll out in 2019. With an outbreak in the region, it is critical for nearby countries to strengthen their own immunity levels and ensure routine immunization and disease surveillance systems are strong enough to detect any virus circulation. Despite the cost and effort of staging national immunization activities, in this case, all partners agree: an ounce of prevention really is worth a pound of outbreak response.

Related resources

“Nothing is impossible”: gaining ground on polio in the Horn of Africa
Is Africa polio-free?
The microplanning puzzle: planning for an effective vaccination campaign
©Gavi/2018/Brendan Esposito.
A health worker administering polio vaccine to a young child.

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.

Related resources

Mobilizing against polio in Papua New Guinea
Papua New Guinea launches comprehensive outbreak response to cVDPV detection
100 days of the polio outbreak response
Left: Shire gives child two drops of the oral polio vaccine to protect them against lifelong paralysis Right: Shire works with vaccination teams to prepare cold boxes to carry polio vaccines

 

I have spent nearly my whole career working on eradication programmes – first smallpox, then polio. Eradication has been a rewarding career for me because I am so curious to know what is happening in the world. Every time I see a disease that we have worked so long to stop returning, I become so unhappy and know I need to work to stop it.

I worked for the smallpox eradication programme back in the 1970s. I was an epidemiologist – this means that my job was to track the disease and plan how we could stop it.

We used to hold vaccination campaigns at night because then we knew everyone would be at home, and we wouldn’t risk missing a single person. As our cars pulled up out of the dark, people would peer out of their houses to see what was happening. Somalis are very curious! As we brought them the vaccine, occasionally someone would make trouble, but mostly people were pleased to see us.

Somalia was the last country where smallpox was found in the whole world. When I knew we had really ended it in 1977, I was so happy. My name was printed there on the certification document – it was something to be proud of. We had freed the world from smallpox!

I remember one of my friends calling me in 1997 to tell me we were going to eradicate another disease, and that we had to look out for something called ‘AFP’. I thought to myself, what is this ‘AFP’? I hadn’t heard of it. They explained to me that it means acute flaccid paralysis – and that it was the symptom of a disease called polio.

Then one day in 1999, I received a call asking if I would come and work for the second eradication programme in my single lifetime. They said, “If you are ready, we will make you a coordinator. We don’t know if there is polio in Somalia or not, but we want you to come and see.” I jumped at the chance.

We started to search, looking for AFP cases, to collect stool samples and then to send them to the laboratory for testing. And soon, we had confirmation that polio was in Somalia. As soon as we found cases, lots of people came from inside and outside Somalia to help.

By 2002, we found the last case of indigenous polio, and thought the game was won. I even joked to my friends saying, what will we do now that polio is eradicated? They said to me, no – we still have polio in Nigeria, Egypt, Pakistan, many other countries – another case will come. We have to be prepared to stop it if it comes.

And true enough, we had an outbreak in 2005, and again in 2013. Each time we stopped it. Last year, we found circulating vaccine-derived poliovirus type 2. Vaccine-derived polio causes paralysis just like wild polio, and we must eradicate it too.

We started to organize ourselves and held two vaccination campaigns. But then we found another virus – circulating vaccine-derived poliovirus type 3. So now, we are responding to two outbreaks that need different vaccines at the same time. If we miss cases and miss getting vaccines to all children, we can’t stop polio. It is hard, but we will end these outbreaks just as we ended wild polio before.

Eradicating polio has been very difficult – more difficult than it was to end smallpox. I suffered – me and my wife were even kidnapped once. But I am always motivated to keep going. My motivation was never my salary – to stay alive, I need to work. I must know what is going on in my country, if my people are safe. From morning until night, my job is to make sure activities can go on peacefully. My family are my true reason for committing my life to eradication. I have seven children, and 30 grandchildren; I never once missed getting any of them vaccinated. Never.

I am sure that we will finish this job. When we eradicate polio, I will be so happy – I will have been involved in the certification of the second human disease ever to be eradicated. I feel so lucky to have spent my life working for these two eradication programmes; I am proud to tell stories to my grandchildren of my life’s work.

Eradicating polio won’t take a miracle. It is a job. It needs a lot of hard work to end an outbreak. There is no other way – the only way is to work hard, to find cases, and to respond. We hope that in the coming months we will make it. I do believe we will make it. Inshallah.

Related resources:

Somalia celebrates 3 years polio free: WHO urges continued caution
Polio outbreak in Somalia officially over
Vaccination in Somalia: “It’s my Job”
A frontline worker is vaccinating a child against polio.                                                                                                                                                 WHO Afghanistan/R Akbar

In November, polio vaccination teams across Afghanistan targeted 5.3 million children under the age of five in high-risk provinces. The vaccination campaign came on the heels of several newly reported cases.  Afghanistan has 19 documented cases of wild poliovirus in 2018, as of November. Confirmation of even one polio case anywhere signals remaining vaccination coverage gaps which must be filled to achieve eradication.

The targeted vaccination campaign took place from 5-9 November, and with support across the board from healthcare workers, communities, religious clerics, and the government. “The Ministry of Public Health and health partners are committed to ending this disease,” said Dr. Ferozuddin Feroz, Minister of Public Health.

Afghanistan is one of the three remaining endemic countries in the world along with Pakistan and Nigeria. The endemic countries are intensifying their efforts by making sure they fully implement the strategies in their national polio emergency action plans.

Read more about the details of Afghanistan’s vaccination campaign here.

Related Resources

Ending Polio in Afghanistan: Big Plan, Small Details
Polio Vaccination, Again?
Meeting Every Child’s Right to Vaccines in Afghanistan
A nation-wide immunization campaign helped in eradicating polio in India. WHO/2011

Eradicating polio in India was a feat of dedication, commitment and simply doubling down on immunization activities. Given India’s vast population, tropical climate in many parts of the country, and other environmental challenges, it would be easy to imagine that if polio couldn’t be stopped, India would be the place to fail.

Simply put: it was a challenge. After all, India constituted over 60% of all global polio cases as recently as 2009.

However, in 2014, India was officially declared polio-free, along with the rest of the South-East Asia Region. Thanks to the singular commitment of the Indian Government at all levels, partners of the Global Polio Eradication Initiative, notably WHO, Rotary International and UNICEF, polio was tackled head-on. India has not had a case single case of wild polio virus since 2011.

India had long been considered one of the most difficult geographical locations to eliminate the disease. Success in India really changed the game, and now serves as an example that eradication of polio is indeed possible when the world marshals political will and commits adequate resources to the cause that affects everybody worldwide.

Today, the world is close to making public health history when it comes to polio – as it was when in 1980 small pox was officially eradicated. The goal of reaching a polio-free world is well within reach.

Tune in to listen to the podcast as the UN Dispatch tells the story of how, against all odds, India wiped out polio, and some of the lessons learned along the way.

Related Resources

A Year Without Polio in India
Aggressive Plans for Eradication in India
India Celebrates Six Years Polio Free
Gafo is the first case of polio in Papua New Guinea in almost two decades. WHO PNG/J.Rivaca

For six-year old Gafo that fateful April 2018 morning was supposed to be the start of just another day full of running around and playing with friends. Ignoring the pain in his legs, Gafo tried to get out of bed, but he fell and struggled to get back up. Over the course of the next two days, Gafo’s condition continued to deteriorate. On the third day, Gafo and his family visited the Angau Memorial General Hospital in Lae, Morobe, in the central northern coast of Papua New Guinea, only to find out that he had polio.

As soon as Gafo’s story broke, a National Emergency was declared by the Government and a mass polio vaccination campaign was initiated. Gafo became the foremost champion of polio awareness, and served as a cautionary tale for families and young children to get vaccinated.

Since his diagnosis, Gafo has made progress. Though he can now walk with his signature gait, Gafo and his parents understand that polio is irreversible, but is preventable and eradicable. Gafo hopes to become a doctor one day. Read about his entire journey from being an ordinary child to breaking news, and how his story has helped contain polio in Papua New Guinea.

This story is originally from the Papua New Guinea Polio Outbreak Response First 100 Days report.

©WHO Pakistan/A.Zaidi

Pakistan’s routine immunization programme Expanded Programme on Immunization will carry out a nationwide measles vaccination campaign targeting around 31.8 million children aged 9-59 months from 15 to 27 October to respond to an ongoing measles outbreak in Pakistan. Over 30 000 measles cases have been reported this year, compared with around 24 000 cases in 2017.

Pakistan typically encounters a measles outbreak every 8 to 10 years, and the Federal Ministry of Health works proactively to stop these outbreaks with regular vaccination campaigns. Although the Polio Eradication Initiative  and the Expanded Programme on Immunization are separate entities, they work together to improve immunization outcomes in Pakistan. Achieving strong essential immunization coverage is a critical step in bringing Pakistan closer to ending polio, and once this goal is reached, in maintaining polio-free status.

Many of the areas at highest risk for polio are also at high risk for measles. During the upcoming measles campaign, the polio programme will lend its human, physical and operational resources, knowledge and expertise to achieve the highest possible measles immunization coverage across the country.

Reaching more children through stronger collaboration

The collaboration between polio and routine immunization programmes has made a significant difference in vaccination efforts across dense urban environments as well as scattered rural settings. A key factor for success has been the polio programme’s highly-skilled workforce of community vaccinators, front-line health workers and social mobilizers.

During every round of country-wide polio vaccination campaigns, around 260 000 front-line health workers vaccinate more than 38 million children under the age of 5 across Pakistan. With vital on-the-ground experience in some of the most challenging settings, they are determined to ensure that the lessons learned in polio are transferred to other health interventions.

“Our front-line workers have built strong rapport in their respective communities,” said Dr. Rana Safdar, coordinator of the National Emergency Operation Centre (NEOC) for polio eradication and member of the National Measles Steering Committee.

“They understand the dynamics of the population, even as they relate to children, not only at the district level but also at the Union Council and village level. This indigenous knowledge coupled with community trust can definitely play an instrumental role for other health interventions.”

Unlike polio eradication activities, measles immunization is not carried out from door-to-door but at fixed centres at health facilities as well as through outreach sessions within communities. Children are mobilized to the vaccination sites where trained healthcare professionals administer the injectable measles vaccine. The deep local knowledge polio workers have developed and the trust they have built with their communities is vital in mobilizing caregivers to take their children for measles immunizations at nearby vaccination sites.

“The strong collaboration between the two programmes has helped us vaccinate more children. Our joint efforts are geared towards reaching every last child and they have shown significant progress so far. We hope that our synergized efforts during the upcoming measles campaign will lead us to reach every child in the target population with measles vaccine,” said Dr. Tahir Abbas Malik, from the Pakistan polio programme.

“For polio, these coordinated efforts have paved the way for increasing the coverage of persistently missed children, especially those who are on the move or reside in hard-to-reach areas. Similarly, integrated micro planning, monitoring and reporting of children who have not received essential immunization  have been instrumental for achieving gains for routine immunization through enhanced coverage,” said Dr. Tahir Abbas Malik.

Pakistan polio eradication programme has achieved significant progress in recent years, thanks to renewed government commitment and revitalized community ownership. However, in cities like Karachi, poliovirus continues to be detected.

Working to overcome the virus once and for all, the polio programme an emergency action plan in January 2018. Since then, the geographical scope of the virus has been noticeably reduced. Much of this progress is thanks to religious leaders like Imam Qari Mehboob, who has spent years building trust and demand for polio vaccination in some of the most difficult areas of the city.

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©WHO Pakistan/Dawood Batozai

Gulshan-e-Buner is in the eastern corner of Karachi. The town includes some of the most impoverished and high-risk populations of the city. Playing in the streets, playgrounds and compounds that wind up and down the hilly landscape are around 2200 boys and girls under five years old. The places where they learn to crawl, walk, and run are perfect hiding spots for the paralysing poliovirus, but the last detection in the environment was in June 2016. No child in Gulshan-e-Buner has been paralysed by polio since 2014. In a community where vaccine refusal has sometimes caused problems, this represents a dramatic transformation.

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©WHO Pakistan/Dawood Batozai

Gulshan-e-Buner is one of the high-risk areas of Karachi where the polio programme first began community-based vaccination. Religious leaders helped to identify and recruit female vaccinators to reach every child with vaccines, and the area seemed well on the way to becoming polio-free. Then in 2012, an attack on health workers caused vaccination activities here to stop. In the years since, the commitment of religious leaders to ensure security, restore access, and build community trust has been crucial to defeat the virus.

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©WHO Pakistan/Dawood Batozai

Iman Qari Mehboob is 50 years old, a migrant from Khyber Pakhtunkhwa like most of his neighbours. He calls the community to prayer five times a day, and teaches many of the youngest children in the town. A father of four children, he is devoted to keeping them and all the other children in his community safe from the poliovirus. His support of the polio programme has helped increase vaccine trust, boost uptake of routine immunization services, and spark conversations about the vaccine.

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©WHO Pakistan/Dawood Batozai

During every polio vaccination campaign, Qari Mehboob goes from house to house with vaccination teams to check for any unvaccinated children. He speaks to parents who refuse the vaccine for their child, reassuring them that it is safe and effective. He conducts his work under the guidance of the National Islamic Advisory Group for Polio Eradication (NIAG), which educates religious leaders about polio eradication and the unique and important role they can play in protecting all Pakistan’s children from polio.

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©WHO Pakistan/Dawood Batozai

Under the guidance of NIAG, religious leaders are trained on the basics of social mobilization, communication, health, and hygiene. They also learn about the religious justifications for polio vaccination, including examining the arguments and fatwas of influential religious scholars.

Reflecting on his training, Qari Mehboob says, “The toughest job [for the NIAG trainers] is to convince religious clerics because their denial and doubt is deep rooted, but the collective Fatwa [scholarly verdict] of prominent scholars helps a lot”.

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©WHO Pakistan/Dawood Batozai

Since his training, Qari Mehboob has organised community engagement sessions to raise awareness about the dangers of the poliovirus. He often makes vaccination a central theme during his sermons at Friday and Eid prayers.

“I face less resistance because most of the people here know me personally and they rely on me because of my status as a religious cleric.” he says.

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Qari Mehboob also uses the power and platform of his mosque to amplify his voice. He means this literally – sometimes he can be found using a loudspeaker. That’s so that mothers working inside compounds and homes can hear his messages, as well as the fathers who attend prayers. He doesn’t just speak about polio eradication, but also educates his community about personal hygiene, routine immunization and importance of education in Islam.

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©WHO Pakistan/Dawood Batozai

To thank him for his work, the provincial polio eradication programme team gave Qari Mehboob a clock during a Mosque promotional activity a few years ago. Below the time lies a message emphasising the importance of vaccination. Now displayed prominently on the wall of the mosque, the gift reminds parents why the polio vaccine is one of the best gifts that they can give to their children.

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Back out in the streets of his town, Qari Mehboob laughs with local children as he checks their finger marking to make sure that they are vaccinated.

Discussing his motivation, he says, “These children are my own children. So I must protect them from any harmful disease - especially from a crippling disease like polio.”

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At the end of the day’s campaign, Qari Mehboob offers tea and cookies to members of the provincial polio eradication programme team.

Since he joined the programme, vaccine refusals in Gulshan-e-Buner have dropped by 50%, and far more children receive their full polio vaccine doses on time.

Reflecting on the impact of his work, Qari Mehboob returns to his desire to keep all children safe. “I feel an extreme level of contentment after I contribute my part in the programme,” he says.

In the Democratic Republic of the Congo, emergency response has been ongoing since 2017 to overcome outbreaks of circulating vaccine-derived poliovirus, caused by low rates of routine immunization. In the battle to close the outbreak, health workers, partners of the Global Polio Eradication Initiative, Governors of affected provinces, and the Ministry of Health are working together to vaccinate every child. In a context with weak health systems and other high-profile health and humanitarian emergencies, these united efforts are crucial to boost population health and keep all young children safe from paralysis.

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In Tanganyika province, where poliovirus was first detected in September 2017, outbreak response is focused on reaching all vulnerable populations with the safe, effective oral polio vaccine. Health infrastructure is weak in the province, and it has taken concerted efforts to reach many children. Here, mothers with their babies queue for polio immunization activities in Manono district, organized with the support of WHO, UNICEF and partners.

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Despite several campaigns, immunity gaps still remain. Continuing cases from several virus strains in the country show that the battle to protect every child from paralysis is far from over. Here, a nurse carefully places vaccines vials back in a cooler during immunization activities in Manono. It is critical that the polio vaccine is kept cool, a considerable challenge in warm locations far from the nearest vaccine storage facility.

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A small boy is vaccinated against polio after waiting in line with his mother. The Democratic Republic of the Congo has some of the lowest vaccination rates worldwide, and it is hoped that the lessons learned in overcoming this and other health emergencies will help strengthen the country’s health system for the future, and prevent other outbreaks.

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A community mobilizer tells a woman in a village in Manono about the polio vaccination campaign that has just begun. Community mobilizers, usually local people trained by UNICEF and partners, are a critical part of efforts to ensure that every child is protected from the virus. Going house to house, they speak to parents about the dangerous poliovirus, and answer questions about the vaccine. Often, they also provide other health service support, including child and maternal health advice.

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© UNICEF/Serge Wingi

A girl has her little finger marked after being vaccinated against polio. All children under the age of five are being targeted in vaccination campaigns in the affected districts.

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© UNICEF/Serge Wingi

Amongst the communities here, there are children whom the virus has already reached. Remy Muyombi was previously an opponent of vaccination. Since his three-year-old son Justin was affected by polio paralysis, he has become a strong advocate of the campaigns ongoing in his district. So far in 2018, there have been eleven confirmed cases of polio paralysis due to the outbreak. In 2017, 22 children were paralyzed.

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A community health worker crosses a shallow stream with his bike to reach the most distant children in Manono health zone. Many communities here live hours from the nearest road, far from any route that a car could easily traverse.

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After a household is visited with vaccines, health workers mark the home with chalk to show that the children there have been immunized. They also collect paper records of vaccination, to feed back into a central monitoring and evaluation system coordinated by WHO.

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© UNICEF/Serge Wingi

Community mobilizers speak to a mother in Kalunga site for internally displaced people in Tanganyika Province. Regular movement of people in the Democratic Republic of the Congo complicates outbreak response, as there is a real threat of virus spread. The programme works specifically with moving and displaced populations to boost immunization rates, and collaborates with other UN agencies to gather up-to-date information on population movements and the wider humanitarian situation in the country.

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A girl is vaccinated against polio in Manono. With each campaign, the polio eradication programme is looking to protect more children, and get closer to ending the outbreak. More polio immunization activities are planned for the coming months, building on commitment from the government of the Democratic Republic of the Congo and provincial governors. Working with other programmes, and in complex contexts, the polio eradication teams continue their work to keep every child safe from polio paralysis.