Looking back on 2020, silver linings are few and far between. The global coronavirus pandemic has brought a year of calamity and continues to devastate, taking lives and livelihoods, leaving in its path grief, fear and as-yet unanswerable questions.
But even amidst the wreckage, for polio eradicators around the world, today is a special day: World Polio Day. It is a day when we reflect on progress, lessons learned, and the worthiness of the goal that has often felt just within our grasp – the eradication of polio. With the number of polio cases across the region at a five-year high and still rising, it would be easy to write this year off as a disaster for the polio program, yet another casualty of COVID-19. But I don’t agree with that assessment, and I’ll tell you why. For the polio program in our region, 2020 has very unexpectedly been the year of reinvention and resilience.
In March, as COVID-19 began to spread with speed and case numbers started rising, our colleagues across the region performed the most remarkable pivot we have seen in public health, applying their tools and resources to a brand-new foe. The case and contact tracing networks that the polio program has taken decades to build pivoted in an instant to tracking COVID-19 cases and their close contacts. In country after country, surveillance staff intensified their efforts checking thousands of patients a day, shifting focus to a new set of symptoms: fever, cough, sore throat and headache.
Polio officers became COVID officers, donning personal protective equipment (PPE) and taking swabs for testing. Health workers and social mobilizers expert in talking to parents about polio and vaccination turned to the new subject everyone was worried about. They answered questions, listened to fears, and showed millions of parents how to properly wash their and their children’s hands. Community awareness matters, and the polio program developed this quickly and effectively, often in communities that had been skeptical of vaccines and even hostile to the polio program. Vital, longed-for bridges were built.
In Pakistan, the strong capacity to collect and analyze real-time data in the polio eradication Emergency Operations Center served as the most important source of disease intelligence and evidence, guiding high-level national and provincial decision making for the response to the pandemic.
Alongside this enormous new challenge, the polio program continued to surveil for polio symptoms, the most pronounced of which is acute flaccid paralysis in a child’s body – the sudden loss of muscle tone and strength in a limb. But by the end of March, vaccination activities had come to a halt: it was simply too risky to send vaccinators out at a time like this.
Across the region and the global polio eradication program, we scoured the facts, assessed and re-assessed the fast-shifting situation on the ground, and came up with a set of protocols to safely vaccinate children against polio, even in the midst of the pandemic. When the world was clamoring for masks and gloves and PPE, the polio program secured a supply line of these vital tools, often locally, and got them to teams in the field. Thousands of polio workers across the region were trained on this new way of working – no easy feat in places like Somalia, Sudan and Yemen, with limited movement and fragile infrastructure.
In July, we got back to the work of polio vaccination, with campaigns in Pakistan, Afghanistan, Syria and parts of Yemen. Somalia followed in September, and campaigns are planned to commence imminently in Sudan and Yemen. COVID-19 cost us the opportunity to vaccinate 50 million children. There is a large and growing immunity gap, not just to polio but also to measles, diphtheria and other vaccine-preventable diseases, and it threatens the lives of hundreds of millions of children across our region.
For too many children, the return to vaccination came too late. Wild poliovirus has paralyzed 132 children in Pakistan and Afghanistan this year, and outbreaks of vaccine-derived poliovirus (VDPV), a strain that emerges in chronically under-immunized populations, have paralyzed children there and in Somalia, Sudan and Yemen.
We are on the back foot, there is no doubt of this. But we know what we need to do: vaccinate every child under age five with polio vaccine. And with new tools on the horizon like novel oral polio vaccine (nOPV), a more effective vaccine for control of VDPV outbreaks, we are hopeful of picking up speed as we move towards our goal. But the thing that fills me with the most hope is the test the polio program has just been through. We knew we could trace contacts, and we knew we had built impressive inroads into some of the region’s most isolated communities. We knew how to talk to parents. But we had no idea just how foundational our people and our infrastructure were to healthcare systems in the most vulnerable communities in our region, and what a critical role they play in our regional vision of health for all, by all. Now, we know – and today is a day to celebrate it.
Earlier this month I hosted the 67th session of the WHO Regional Committee for the Eastern Mediterranean – a meeting of health ministers and high-level representatives from the 22 countries in this region, along with partner organizations and civil society. Polio was one of the top issues on the agenda, both for its efforts in eradicating the disease off the face of the earth, and its key contributions to the regional response to COVID-19. As I listened to colleagues from the polio program describe their year, including the loss of three colleagues to COVID-19, health workers who paid the ultimate price for their dedication, I felt humbled and grateful.
RC67 ended on a high note for the polio program, with broad support for the formation of a new Regional Subcommittee focused on gathering the political will to get us over the line and finally achieve eradication. When we have done this – and I have no doubt we will do it – we will also have something else: a remarkable public health machine, staffed by some of the most dedicated health workers I have met, ready to tackle its next challenge.
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