As the world adjusts to the idea of coexisting with the coronavirus for the foreseeable future, global health organizations are making plans to eradicate another scourge that has persisted for thousands of years: the poliovirus.
The Global Polio Eradication Initiative, a public-private partnership led by national governments and health groups, on Wednesday released a $ 5.1 billion plan to eradicate polio by 2026.
Polio can cripple or even kill people who have it. For decades, the initiative has attempted to achieve a polio-free world by immunizing every child against the virus, but with limited success.
Many countries faced sporadic polio outbreaks before the coronavirus emerged, but the pandemic halted some polio vaccination programs, at least for a few months, and worsened the trend. Last year, there were 1,226 cases of polio worldwide, up from 138 in 2018.
There was also good news. In August, African countries were declared free from wild poliovirus, leaving Afghanistan and Pakistan as the only two polio endemic countries. And in November, the World Health Organization granted the first emergency clearance for a new vaccine that promises to minimize polio outbreaks.
“Now is the time to double down and really make sure we stop transmission and are able to create a polio-free world,” said John Vertefeuille, head of the polio eradication arm 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 inadequate funding and a lack of political commitment – factors that can pose an even more difficult challenge now, with Covid-19 continuing to siphon off attention and resources.
The new strategy includes policies to increase political commitment while taking into account the pandemic, said Dr Vertefeuille. It encompasses two key objectives: to integrate polio programs with other health care programs and to focus on areas with chronically low immunization rates. The plan also secures vaccine supply and outlines a communication strategy to increase vaccine acceptance.
The architects of the plan consulted more than 40 civil society organizations, academic institutions and donors to help them integrate polio eradication with other health challenges.
Trying to involve communities in areas where there is hesitation, even hostility, towards vaccines “is easier said than done, obviously, but at least in my opinion, it’s in the right direction, ”said Dr. Walter Orenstein, associate director of the Emory Vaccine Center and former director of the US immunization program.
Dr Orenstein was optimistic about the new strategy as a whole, and in particular the tactic of combining polio with other health programs to gain political support.
“Eradication is a very ruthless goal – one infection is one infection too many,” he said. But the new plan “has made it clear that they are taking into account the lessons they have learned.”
From March to July last year, polio vaccination campaigns were suspended in more than 30 countries, resulting in more unvaccinated children and more outbreaks of vaccine-derived polio.
The oral polio vaccine which is currently widely used contains a weakened strain of the virus. Children who are immunized with this vaccine can pass the virus into the environment through their stool; from there it can infect unprotected people. As the virus passes from one unvaccinated person to another, genetic changes can cause it to revert to a form that can cause paralysis.
About 90 percent of polio outbreaks are the result of this vaccine-induced poliovirus. In 2020, more than 1,000 cases were detected in 29 countries, many more than in previous years. A new oral vaccine introduced in November is designed to make the virus more genetically stable and is believed to minimize the risk of vaccine-induced cases.
“This is not a silver bullet that will solve all of our problems – vaccines have yet to reach people for them to work,” said Simona Zipursky, WHO polio eradication adviser. “But we think it will really help us stop these epidemics in the long term. “
The new vaccine is only approved for emergency use, and eligible countries must commit to monitoring its safety and effectiveness. More than 20 million doses have already been distributed.
Outbreaks of wild poliovirus – the original scourge – now only occur in Pakistan and Afghanistan. Since 2018, vaccination campaigns have missed an estimated 3 million children in Afghanistan due to the Taliban’s ban on home vaccination. The vast majority of epidemics in Afghanistan in 2019 and 2020 originated in these regions.
“Understanding how we can access it by engaging with them remains a key objective of the program,” said Dr Vertefeuille, referring to the Taliban.
In Pakistan, Pashto-speaking communities close to the Afghan border make up about 15 percent of the country’s population, but over 80 percent of wild polio cases. Reluctance to vaccinate and misinformation disseminated via social media has led to an increase in cases since 2018.
“These problems certainly existed before, and the Covid breaks have allowed the number of cases to increase quite dramatically, quite quickly,” said Dr Vertefeuille.
Polio eradication programs will focus on immunizing hard-to-reach communities in both countries and training older female health workers, who are more successful in persuading caregivers to immunize their children.
The global initiative has set up two teams to respond to outbreaks within 72 hours: one in the Eastern Mediterranean region (which includes 21 countries, including Pakistan and Afghanistan), and the other in Africa sub-Saharan. This time around, the strategy also involves health ministers from the Eastern Mediterranean region, so governments are urged to focus on polio by their peers, rather than a world health organization.
“Eradication remains a major health priority,” said Dr Faisal Sultan, Special Health Assistant to the Prime Minister of Pakistan. “We look forward to working with international partners to achieve a polio-free world. “
Nigeria, another polio-endemic country, was declared polio-free last June after facing some of the same challenges. The commitment of political leaders at all levels of government, including immunizing their grandchildren on television, has turned the tide.
To restore polio as a priority, even with competing health challenges in these cash-strapped countries, officials point out that programs to eradicate polio can also be used to help roll back Covid-19 and other diseases , said Dr Vertefeuille: “This allows you to be prepared for any emergency.
During the coronavirus pandemic, more than 31,000 polio workers in more than 30 countries focused on Covid-19 surveillance, contact tracing, distribution of hand hygiene supplies and training medical staff and frontline workers.
In Pakistan, polio labs have performed testing and sequencing for the coronavirus, and a polio hotline has become the national clearinghouse for information on Covid-19. Polio workers trained nearly 19,000 health workers and engaged 7,000 religious leaders and 26,000 influencers.
In Nigeria, health workers used data systems and analytics set up for polio to track health care needs for Covid-19. Polio officers were also helpful during the Ebola outbreak in Nigeria.
In Pakistan and Afghanistan, polio vaccination was associated with the delivery of other vaccines or other essentials, such as vitamin A and deworming tablets. Polio officers may also combine their vaccination efforts with the delivery of Covid-19 vaccines, even if children vaccinated against polio are too young for coronavirus vaccines.
At the same time, confusion over Covid-19 vaccines has affected polio vaccination campaigns, said Melissa Corkum, senior director of polio outbreak response at Unicef. Polio workers “have to spend a lot more time educating and communicating on the doorstep with parents and caregivers,” she said.
In Nigeria, the first country to introduce the new polio vaccine, the vaccination campaign began “almost parallel to the deployment of Covid, it may have taken place on the exact same days and in slightly different areas,” said Ms. Zipursky said.
Polio workers faced many questions and concerns regarding the two vaccines, she said, stressing the need to prepare with the right information. “It was really a good lesson learned.”