As the world adjusts to the idea of coexistence with the coronavirus for the foreseeable future, global health organizations are setting plans to eradicate another scourge that has been around for thousands of years: the poliovirus.
The Global Polio Eradication Initiative, a public-private partnership led by national governments and health groups, released a $ 5.1 billion plan to eradicate polio by 2026 on Wednesday.
Polio can paralyze or even kill people. For decades, the initiative has tried to achieve a polio-free world by vaccinating every child against the virus, but with limited success.
Many countries struggled with sporadic outbreaks of polio before the coronavirus emerged, but the pandemic stalled some polio vaccination programs for at least a few months and exacerbated the trend. There were 1,226 cases of polio worldwide last year, compared to 138 in 2018.
There was some good news too. In August, African countries were declared wild polio-free, making Afghanistan and Pakistan the only two countries where polio is endemic. And in November, the World Health Organization issued the first emergency approval for a new vaccine designed to minimize polio outbreaks.
“Now is the time to double up and really make sure we can stop the transmission and create a polio-free world,” said John Vertefeuille, director of polio eradication at the Centers for Disease Control and Prevention. one of the partners of the global initiative.
Previous efforts to end polio have been hampered by insufficient funding and lack of political engagement – factors that may be even more challenging now as Covid-19 continues to draw attention and resources.
The new strategy includes measures aimed at increasing political engagement while taking the pandemic into account, said Dr. Vertefeuille. It has two main objectives: to integrate polio programs with other health programs and to focus on areas with chronically low vaccination rates. The plan also ensures vaccine supplies and outlines a communication strategy to increase vaccine acceptance.
The plan’s planners have consulted with more than 40 civil society organizations, academic institutions and funders to help them integrate polio eradication with other health challenges.
Trying to engage communities in regions where vaccines are hesitant or even hostile “is easier said than done, of course, but at least in the right direction in my opinion,” said Dr. Walter Orenstein, associate director of the Emory Vaccine Center and former director of the United States vaccination program.
Dr. Orenstein was optimistic about the new strategy as a whole, and particularly the tactic of combining polio with other health programs to gain political support.
“Eradication is a very unforgiving goal – one infection is one infection too many,” he said. But the new plan “has clearly shown that they take the lessons learned into account”.
Polio vaccination campaigns were suspended in more than 30 countries from March to July last year, leading to more unvaccinated children and more outbreaks of vaccine-based polio.
The oral polio vaccine currently in widespread use contains an attenuated strain of the virus. Children vaccinated with this vaccine can spread the virus into the environment through their feces; from there it can infect unprotected people. When the virus passes from one unvaccinated person to another, genetic changes can cause it to revert to a form that can cause paralysis.
June 10, 2021, 9:50 a.m. ET
About 90 percent of polio outbreaks are due to this vaccine-induced poliovirus. More than 1,000 cases were detected in 29 countries in 2020, much more than in previous years. A new oral vaccine introduced in November aims to make the virus more genetically stable and to minimize the risk of vaccination cases.
“It’s not a silver bullet that will solve all of our problems – the vaccines still have to reach people for them to work,” said Simona Zipursky, WHO adviser on polio eradication. “But we believe it will really help us stop these outbreaks on a sustainable basis.”
The new vaccine is approved for use in emergencies only, and countries that qualify for it must commit to monitoring its safety and effectiveness. More than 20 million cans have already been distributed.
Outbreaks of the wild poliovirus – the original scourge – now only occur in Pakistan and Afghanistan. As of 2018, vaccination campaigns have missed about 3 million children in Afghanistan because of a Taliban ban on house-to-house vaccination. The vast majority of outbreaks in Afghanistan in 2019 and 2020 came from these areas.
“Understanding how we can gain access through dialogue with them remains a key focus of the program,” said Dr. Vertefeuille with a view of the Taliban.
In Pakistan, Pashtu-speaking communities near the Afghan border make up about 15 percent of the country’s population, but more than 80 percent of wild polio cases. Vaccination hesitation and misinformation disseminated via social media have increased the number of cases since 2018.
“These problems have certainly existed before, and the Covid breaks caused the number of cases to increase dramatically pretty quickly,” said Dr. Vertefeuille.
Polio eradication programs will focus on immunizing hard-to-reach communities in the two countries and training older female health workers who are more successful in convincing caregivers to vaccinate their children.
The global initiative has put together two teams to respond to outbreaks within 72 hours: one in the Eastern Mediterranean (which includes 21 countries, including Pakistan and Afghanistan) and the other in sub-Saharan Africa. This time around, the strategy also involves health ministers in the Eastern Mediterranean, urging governments to focus on polio from their peers rather than a global health organization.
“Eradication remains a top priority in the health sector,” said Dr. Faisal Sultan, Special Envoy for Health to the Prime Minister of Pakistan. “We look forward to working with international partners to achieve a polio-free world.”
Another country where polio is endemic, Nigeria was declared polio-free last June after facing some of the same challenges. The engagement of political leaders at every level of government – including vaccinating their grandchildren on television – turned the tide.
To reintroduce polio as a priority even with competing health challenges in these financially tight countries, officials stress that polio-suppression programs can also be used to roll back Covid-19 and other diseases, said Dr. Vertefeuille: “It enables you to be prepared for any emergency.”
During the coronavirus pandemic, more than 31,000 polio workers in more than 30 countries worked on Covid-19 surveillance, contact tracing, hand hygiene supplies distribution, and training for medical and frontline staff.
In Pakistan, polio laboratories offered tests and sequencing for the coronavirus, and a polio phone line became the national information center for information on Covid-19. Polio workers trained nearly 19,000 health care workers and employed 7,000 religious leaders and 26,000 influencers.
In Nigeria, health workers used data systems and analytics put in place for polio to track health needs for Covid-19. Polio workers were similarly helpful during the Ebola outbreak in Nigeria.
In Pakistan and Afghanistan, polio vaccination has been bundled with the supply of other vaccines or other health necessities such as vitamin A and deworming tablets. Polio workers can also combine their vaccination efforts with deliveries of Covid-19 vaccines, even though the children vaccinated against polio are too young for coronavirus vaccines.
At the same time, confusion over Covid-19 vaccines has impacted polio vaccination campaigns, said Melissa Corkum, senior manager of polio outbreak response at Unicef. Polio workers “need to spend a lot more time educating and communicating with parents and caregivers on their doorstep,” she said.
In Nigeria, the first country to introduce the new polio vaccine, the vaccination campaign began “almost in parallel with their Covid rollout, it could actually have been on the same days and in slightly different areas,” said Ms. Zipursky.
Polio staff faced many questions and concerns about the two vaccines, she said, highlighting the need to be prepared with the right information. “That was a really good lesson.”