This month, like most months, polio vaccinators fanned out across Afghanistan and Pakistan, bearing cold boxes full of vaccine to be dropped into the mouths of children at risk of contracting polio and developing lifelong paralysis.
As has become the norm since the Covid-19 pandemic began, they wore masks, sanitised their hands between visits, and practiced a no-touch technique to maintain some physical distance.
But something has changed in the way these vital health workers do their jobs. It’s a change that runs from ground level, through the men and women who knock on doors, to the campaign planners to the policymakers, donors and governments who shape and steer the polio programme.
The change is simple: ownership. Ownership of the problem, and ownership of its solution.
Ours is the world’s last region to battle wild poliovirus, and we have battled it for too long. As ministers of health and political leaders, we have also relied for too long on other individuals and organisations to lead us on a journey that is ours to drive. Embracing the challenges that lay before us now and learning from them is very much in keeping with the World Health Organisation’s vision for the region, Vision 2023: Health for all by all. Only by stepping up to tackle this head on, together, can we achieve our shared goal.
In a landmark event on March 16, 2021, ministers of health from across the region came together in the inaugural meeting of WHO’s Regional Subcommittee on Polio Eradication and Outbreaks. This new assembly is a platform for us as member states of the region to come together as problem-solvers. To share concerns and priorities. And to support each other, directly. We share borders and populations: polio circulating in Pakistan or Afghanistan is a risk to both countries and to Iran, and beyond. We share risks. But we also share rewards.
The Global Polio Eradication Initiative (GPEI) is a vital engine driving forward the mission to end polio forever. Through the GPEI, the funds, expertise, laboratory support and people we need to achieve our goal work in a smart, targeted manner. The GPEI’s new strategy for eradication, covering 2022-2026, and to which we all contributed, charts the course we must take to reach our goal. But we must move forward with individual member states and their most affected communities at the helm.
The introduction of novel oral polio vaccine type 2, an improved version of the workhorse of the polio programme, could truly change the game for eradication of the vaccine-derived poliovirus (VDPV). Results from the African and European regions are very promising. But it is down to individual member states to meet the criteria for readiness to use this vaccine — requirements around cold chain, logistics, disease surveillance and communication capacity. This vaccine promises to be the definitive solution to stop persisting VDPVs in Somalia, but also in Sudan, Egypt and Iran where such strains have recently moved across borders.
Access, we know, is the critical piece of the puzzle: we cannot eradicate until we reach and vaccinate every child, multiple times. Afghanistan’s complex and still-shifting landscape makes this enormously challenging, but we believe the solution lies in-country, in Afghan hands. As regional public health leaders, we remain committed to facilitating access to all children with life-saving vaccines.
The quality of campaigns has long dogged our quest for eradication. To understand the complexity of a large-scale polio campaign, you need to see it up close, the thousands of workers knocking on millions of doors over a period of days, the punishing temperatures and hours and the painstaking effort to reach every last child. We know the quality of campaigns must be improved. Corners cannot be cut. Local administrators and health leaders must take full responsibility to monitor and facilitate the work of frontline workers to reach all, particularly children who are repeatedly missed.
We also need to raise the quality of surveillance, which includes searching for poliovirus in sewage runoff, and searching for acute flaccid paralysis, polio’s primary symptom, in children. As we edge closer to eradication, we must hunt the virus like never before, so that when we finally declare an end to polio, we can do so with ironclad certainty that it is gone from this earth, and not just hiding under a rock we haven’t lifted.
Across this region, in the past 15 months, national polio programmes have proven their worth in their response to the Covid-19 pandemic. In Afghanistan, Pakistan, Somalia, Sudan, Syria and beyond, the same workforce is responding to Covid-19 and polio. This is a workforce that can deliver exceptional results in the most challenging of conditions. And now, we must ask those workers to dig deep and finally end polio for good. With our own leadership charting the way, and with the GPEI and sufficient donor and national financing behind us, we know we can succeed. There is no other option.
Dr AbdulRahman bin Mohamed Al Owais is UAE’s Minister of Health and Prevention and Dr Hala Zayed is Minister of Health and Population, Egypt. They are co-chairs of the World Health Organisation’s Regional Subcommittee for Polio Eradication and Outbreaks, Eastern Mediterranean Region.
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