How Africa beat wild polio

Eradicating diseases is possible with enough co-operation, the WHO's Africa director explains

A child reacts as he receives an injection during the nationwide vaccination campaign against measles, rubella and polio targeting all children under 15 years old in Nkozi town, about 84 km from the capital Kampala. AFP

A Health worker administers a vaccine to a child during a vaccination campaign against polio at Hotoro-Kudu, Nassarawa district of Kano in northwest Nigeria. AFP

A South Sudanese child plays in a street after visiting a mobile clinic in Rejaf. AFP

A child reacts as he receives an injection during the nationwide vaccination campaign against measles, rubella and polio targeting all children under 15 years old in Nkozi town, about 84 km from the capital Kampala. AFP

A boy receives drops of polio vaccine by a home-visited nurse after the launching ceremony of the five-day polio vaccineation campaign in high risk counties, targeting about two million children under five years old, in Kajiado, Kenya. AFP

A child is vaccinated during a launching ceremony of the five-day polio vaccineation campaign in high risk counties, targeting about two million children under five years old, in Kajiado, Kenya. AFP

Health workers walk from house to house in search of children to immunise during vaccination campaign against polio at Hotoro-Kudu, Nassarawa district of Kano in northwest Nigeria. AFP

The UAE has been critical to the fight against polio globally. With crucial support from the Emirates, 25 million children were immunised in the Horn of Africa helping to stop an outbreak in 2013 and 2014.

On August 25, Africa declared victory over wild poliovirus, which once paralysed 75,000 children on the continent annually. Now four years have passed since wild polio was last detected in Africa. After a year of rigorously evaluating polio data from all 47 WHO African Region countries, an independent body of experts announced during a virtual certification ceremony this week that they are wild polio-free.

The magnitude of this achievement cannot be overstated. And amid Covid-19, it should inspire confidence in the region’s ability to overcome even the most formidable public health challenges.

How we got here is a remarkable story that shows what Africa can achieve when we unite behind a common goal. In 1996, African heads of state committed to eradicating polio during the 32nd Ordinary Session of the Organisation of African Unity in Yaounde, Cameroon. In the same year, Nelson Mandela launched the “Kick Polio Out of Africa” campaign, with the support of Rotary International. African nations answered his call, setting in motion historic levels of international co-operation. In 2000, the first multi-country synchronised polio vaccination campaigns reached 76 million children across 17 countries in West and Central Africa. Two million of these children had never been vaccinated.

Sixteen years and billions – yes, billions – of polio vaccinations later, Africa’s last wild poliovirus outbreak hit northern Nigeria in 2016. Recognising the risk of international spread, the region rapidly mobilised a response. With support from the Global Polio Eradication Initiative (GPEI), a special task force was set up to help Nigeria, Niger, Cameroon, Chad and the Central African Republic coordinate and roll out an emergency outbreak response campaign to reach 45 million children.

Multi-country campaigns on this scale are extraordinarily complex. Each country’s surveillance and vaccination teams must work with their counterparts to plan and implement campaigns over vast areas, using detailed micro-planning to ensure every settlement is reached.

The diversity of Africa’s terrain, cultures and languages, along with disruption of health systems due to mass migration, conflict and climate change, have created additional challenges.

Africa’s polio eradication programme responded to these obstacles by constantly innovating and adapting its strategies. The programme developed a unique technique to reach children in insecure areas of the Lake Chad basin. Special transit teams were established in fixed locations with heavy traffic, like markets and border checkpoints. In 2017 alone, transit teams stationed in just one Nigerian city vaccinated 299,000 children moving out of conflict-afflicted areas of Borno State.

The infrastructure and expertise developed to fight polio have played a major role in strengthening other health services across the region. In Chad, innovative polio vaccination strategies are used to reach nomadic populations with perinatal health and routine immunisation services. Across the continent, thousands of polio workers integrate surveillance for other diseases in their search for polio cases, which has helped scale up surveillance networks.

Today, the polio programme is playing an important role in Africa’s fight against Covid-19. Polio staff and resources are supporting countries to co-ordinate outbreak response, educate the public and conduct contact tracing, data management and surveillance.

But history has shown us that we must remain vigilant. While the wild virus is no longer circulating in Africa, the disease continues to infect children in Pakistan and Afghanistan. In the early 2000s, international spread of wild polio from India to several African countries showed how easily the virus can reappear if we let down our guard down. Until polio is eradicated globally, all countries need to maintain high population immunity levels to protect against wild polio importation.

High vaccination rates are also needed to stop outbreaks of circulating vaccine-derived polio (cVDPV), which can occur when not enough children receive the oral polio vaccine. Sixteen countries in the region are currently experiencing cVDPV outbreaks. Unfortunately, cVDPV transmission is expected to increase following the temporary pause in vaccination campaigns that was necessary to mitigate the spread of Covid-19. But we are encouraged that some countries have restarted cVDPV response campaigns, under the strict implementation of the Covid-19 infection prevention and control guidelines to protect communities and vaccinators.

This week’s certification ceremony – which was joined virtually by some African Heads of State, Ministers of Health, GPEI leadership and polio programme funders – was a moment to honour the heroic vaccinators, technical experts and community mobilisers who made this historic achievement possible. As we celebrate, we must remember that this progress is fragile. We must redouble our commitment to keep wild polio out of Africa, and end cVDPVs.

We know the path ahead will not be easy. We are faced with the serious new obstacle of Covid-19, but we have overcome setbacks before. And this time, we are armed with expertise and infrastructure developed by the polio programme over decades, and proof that no challenge can shake the commitment of African political leaders and polio staff.

The region’s triumph over wild polio leaves no doubt in my mind that when we act together, Africa can achieve even the most ambitious public health goals.

Dr Matshidiso Rebecca Moeti is the regional director for Africa at the World Health Organisation