A child receives an oral polio vaccine in Peshawar, Pakistan. Credit: Ashfaq Yusufzai/IPS.

By Andy Hazel
UNITED NATIONS, Dec 30 2016 (IPS)

Childhood immunisation is one of the safest and most cost-effective health interventions available, yet many of the world’s most vulnerable children continue to miss out.

A World Health Organisation report entitled State of inequality: childhood immunisation was released last week. While the report is mostly good news, immunisation rates are up and many countries have eradicated diseases entirely, a large population of children remain unimmunised.

To better reach these children the authors also looked at another metric: disease as a marker of inequality. Or, in the words of Robin Nandy, Principal Adviser and Chief of Immunisation at UNICEF, “a virus doesn’t lie”.

“The presence of disease is the best indicator of where a bigger problem is,” he explains. “Diseases tend to show up where there are weak systems of health coverage and in areas of conflict.”

“It is very likely that where there is low immunisation coverage there are multiple deprivations.”

“The nutritional status of the kids in these areas could be compromised, they could lack water or sanitation, common childhood illnesses such as diarrhoea or pneumonia could be present.”

Using data from 69 countries, the study examined inequality amongst rates of childhood immunisation and measured changes in rates of immunisation over the last ten years. The most prominent inequalities recorded were those of household economic status and the level of maternal education.

While the report showed that rates of immunisation for diseases such as measles, polio and yellow fever are around 85 percent globally, progressing beyond this number is hard and the biggest barrier to progress is political willpower.

“Once you’ve hit 80 percent the remaining 15 to 20 percent tend to be in remote locations, in underprivileged populations,” says Nandy. “In many countries the communities that want immunisation are marginalised. Political will is extremely important to shift the mindset from wide coverage to wide coverage with equality.”

“There are some areas that are right under our noses that we tend not to prioritise because we’re focused elsewhere, like urban slums. Often they don’t show up in population data and that is why they’re not prioritised in health services.”

Nandy points to a rapidly urbanising world and the growing population of children living in refugee camps or moving between regions as key examples of the complex operating environments. “There has to be a proactive and deliberate attempt to reach these populations and it won’t happen by delivering services in a normal way. We need tailored approaches for each country to make sure these populations are reached.”

Polio, which has neared complete eradication but setbacks in 2015-16, illustrates the difficulty of reaching children most in need.

“Where are we still seeing polio transmission?” Nandy asks rhetorically. “It’s on the Pakistan / Afghanistan border, places like Baluchistan and Waziristan, places that have security issues. These limit the access of health workers into that area.”

“You will get increases in rates of diseases like polio when parents cannot bring their kids to clinics.”

The current situation in many countries shows that further improvement is needed to lessen inequalities, and data such as this may prove invaluable.

Women wait to immunize their children at the Kisugu Health Centre in Kampala, Uganda, where free vaccinations take place. The nurse in the foreground is Betty Makakeeto. Credit: Amy Fallon/IPS

By Amy Fallon
KAMPALA, Jun 29 2016 (IPS)

Patience*, a Ugandan maid, planned on taking her three-year-old son for polio immunization during the country’s mass campaigns a year ago, until her landlord’s wife told her a shocking myth.

“The medicine they are injecting them with means the boy when he’s an adult won’t be able to reproduce,” Patience, 32, recalled to IPS what she’d been informed. “She said: ‘Don’t even think about immunization’.”

Patience said that in her neighborhood, the Kyebando slum in Kampala, many families “lied to medical personnel” because they were “terrified” about what this woman had told them.

Earlier this year, the country’s president signed the Immunization Act 2016, prescribing fines, a jail term of six months or both, for parents who don’t vaccinate their children in the age bracket of five days to one year old.“They said the vaccines are made out of pigs, wild animals, (that) our children will behave like wild animals.” -- MP Huda Oleru

The Act also requires the production of an immunization card before admission to day care centres, pre-primary or primary education. It also aims to provide for compulsory immunization of women of reproductive age and other target groups against immunisable diseases.

According to the legislation, passed by Parliament last year, diseases for which immunization is compulsory include tuberculosis, whooping cough, tetanus, hepatitis B, polio and measles.

One in five African children still do not receive all of the most basic vaccines they need, including ones for three critical diseases—measles, rubella and neonatal tetanus – a report issued by WHO at the first ministerial on Immunization in Africa, held in Addis Ababa, Ethiopia, in February.

Uganda was ranked lowest in east Africa for immunization coverage, with one example being the country’s 2014 diphtheria-tetanus-pertussis (DTP3) coverage which was at 78 percent compared to DRC (80 percent) Kenya (81 percent), Tanzania (97 percent) and Rwanda (99 percent).

According to outgoing female MP Huda Oleru, who tabled the private member’s bill in 2011, the biggest obstacle to vaccination in Uganda was the 666 cult made up of more 500 members but “growing” across the country, who refuse to immunize their children.

“They said the vaccines are made out of pigs, wild animals, (that) our children will behave like wild animals,” Oleru told IPS.

Oleru is continuing talks with the groups in eastern Uganda, and said she hoped “in the long-term” they would come around.

But for now the law was the “easiest way” of getting them to immunize their children.

“When I entered Parliament (ten years ago), I realised that we didn’t have an immunisation law, and a law is guidance or directive and it guides us in areas of impunity,” said Oleru.

At least ten members of a Christian group were detained over refusing to vaccinate their children against polio, the Daily Monitor reported last month.

Dr. Henry Luzze, the deputy program manager of the Uganda National Expanded Programme on Immunization, told IPS the government was currently vaccinating against ten diseases. It had submitted an application to GAVI ((the Vaccine Alliance) and received approval to introduce the rotavirus vaccine for diarrhea in children, a “big problem”. They were also looking at introducing a rubella vaccine by 2018 and a second measles vaccination to be given at 18 months.

Measles were still a huge threat, after outbreaks last year in western Uganda, he said.

“We still have some districts and communities that are still below what we want in terms of coverage in the eastern part of the country, areas where there are very high hills and no transport,” said Dr Luze.

Children were also not being vaccinated due to shortages in a number of facilities at a district level, but through recent support from GAVI, Uganda was able to procure solar powered fridges to keep the vaccines in areas prone to power cuts.

The influx of refugees from Burundi, DRC and South Sudan, where immunization rates are low, pose another challenge to Uganda. Late last month at least three cases of yellow fever were confirmed here, with scores of cases suspected.

According to the new Act, “the government shall provide free vaccines and other related services to every Ugandan required to receive vaccination”.

Dr Luzze said the law was good as it was balanced and compels the government to “make sure all the vaccination services are in place”.

“After that, then you commit the parents or the caretakers to make sure all their children are vaccinated,” said Dr Luzze, claiming the legislation “empowers CSOs to challenge the government”, who could be taken to court over shortages.

But there has already been some criticism from Ugandans that the law is too harsh, and during a recent mass polio campaign, held in March, there were reports that about 2,000 children below the age of five missed out on immunizations in Karamoja, northeastern Uganda, according to the country’s Daily Monitor newspaper.

The Act also creates the establishment of an Immunization Fund, house by the ministry of health, to “purchase vaccines and related supplies, cold chains, and funding of immunization outreach activities”.

Sources will be made of up monies appropriate by Parliament for the fund and donations.

“GAVI has been supporting this country so much and they’re still giving, but the challenge is GAVI has its criteria,” said Oleru. “Soon we might become a middle-income country, then we shall not be eligible (for support) under GAVI.”

Luzze said he believed the law would be easy to enforce because “the president, the ministers, the parliamentarians, religious leaders” all supported it.

President Yoweri Museveni was “aggressive” about promoting immunization because he believes it saves “families from spending too much money and time caring for sick members”, among other reasons, said his spokesperson Lindah Nabusayi.

Dr Moses Byaruhanga, the director of medical and health services for Uganda’s police, told IPS the authorities would go on radio talk shows to talk about the law, but would be strict on it.

“Police will be able to find out if (parents) did not take their kids for immunization,” he said, adding health workers, local leaders and schools would be the eyes and ears of the community.

International immunization experts such as Mike McQuestion, director of sustainable immunization financing at Sabin Vaccine Institute in the US, have praised the new legislation as a “textbook example of good governance”.

“The way the Ugandans created this law was itself impressive,” he told IPS. “Several public institutions had to work together to write it, vet it and push it through.”

In late March, about two weeks after it emerged the law had passed, Patience had her son immunized against polio, during a door-to-door mass campaign.

“It was very easy, they just put a drop in the mouth, then a mark on the finger,” she said, adding it took only three minutes.

Patience admitted she had been “partly” worried about going to jail under the new law, and that was the reason she’d chosen to vaccinate her son. But she said the nurse had told her “you shouldn’t not vaccinate him because you’ll be arrested, but because he can get sick”.

“I think now he is free from becoming sick,” said Patience.

*Patience’s name was changed for personal reasons.

A baby cries in his mother’s lap while being inoculated against measles by Vaccinator Joseph Kamara, at Tagweh Town Community Clinic in Bomi County, Liberia. Credit: UNICEF

By Roger Hamilton-Martin
DAKAR, May 4 2015 (IPS)

As Sierra Leone, Guinea and Liberia work to end Ebola, critical healthcare services damaged by the epidemic are beginning to be revitalised.

Supported by United Nations Children’s Fund (UNICEF), the three countries worst-hit by the disease have begun a campaign to immunise three million children against preventable illnesses like measles and polio.“UNICEF trained a former Ebola sensitisation team to go door-to-door explaining to parents that the vaccinations for measles were safe, essential, and not related to Ebola in any way." -- Tim Irwin

The launch of the campaign coincided with World Immunization Week, which ran Apr. 24 to 30. In Guinea, the World Bank has provided funding, whilst in Sierra Leone, funding has come from the Canadian International Development Agency, the European Union and the United States Office of Foreign Disaster Assistance.

Speaking to IPS about the relevance of the campaign, UNICEF West Africa spokesperson Tim Irwin said, “The focus is still very much on getting to zero cases of Ebola, but the reduction in the number of cases has allowed for the resumption of some interventions.

“Immunisations have restarted and UNICEF and partners have supported the governments in the reopening of schools.”

At the end of March, the World Health Organisation said “in light of the decline in Ebola cases, it is urgent to focus efforts on restarting and intensifying immunization activities.”

Currently, the risk of vaccine-preventable disease outbreaks outweighs the risk of increased Ebola virus transmission.

In Liberia, a campaign to provide measles and polio vaccinations to over 700,000 children under five years old is planned for May 8-14. There, measles vaccination rates were adversely affected due to the impact of Ebola on the country’s healthcare infrastructure.

Little more than half of children aged under one year received measles vaccines in 2014. Before the epidemic in 2013, measles coverage was 89 percent, while in 2014 it fell to 58 percent.

Meanwhile, Ebola had a significant impact on Sierra Leone’s vaccination regime, with routine vaccinations decreasing by 17 percent during the epidemic. Since the start of 2015, 21 laboratory confirmed cases of measles have been reported. In May, an immunisation drive for 1.5 million children under five will cover measles and polio.

In Guinea, where a measles outbreak was declared in early 2014 – prior to Ebola – the number of confirmed measles cases increased almost fourfold, from 59 between January and December 2013 to 215 for the same period in 2014, according to WHO. There are currently some 1265 suspected cases of measles in Guinea.

Irwin told IPS that in Guinea, one significant challenge is communicating the safety and importance of vaccines to sections of the population which remain sceptical, and in some cases concerned that vaccinations could be connected with Ebola.

“The second phase of measles vaccination campaign was launched in Forest Region which is still recovering from the psychological trauma of the Ebola outbreak,” Irwin said.

“While there hasn’t been a case that region for months, the UNICEF team and partners took the initiative to conduct a social mobilisation campaign ahead of the vaccinations to ensure that the turnout would be as high as possible.”

Health professionals remain vigilant for cases of Ebola, and are required to wear gloves when vaccinating – a practice not routinely required for administering injectable vaccinations in normal conditions.

As part of the community-sensitisation campaign in Guinea, UNICEF has been conducting door-to-door visits to discuss vaccinations with parents.

“UNICEF trained a former Ebola sensitisation team to go door-to-door explaining to parents that the vaccinations for measles were safe, essential, and not related to Ebola in any way,” said Irwin.

UNICEF health specialist Dr. Rene Ehounou Ekpini told IPS that Ebola had highlighted serious problems in Guinea’s health system. “Firstly, it’s a problem of poor distribution, with most health workers in the capital. At the second level, it’s an infrastructure issue.

“It’s important to restore confidence in the health system,” he said.

Edited by Kitty Stapp

By Anna Shen
NEW YORK, Sep 3 2013 (IPS)

Africa and Pakistan are now battling outbreaks of polio, threatening the extraordinary progress the world has made in fighting the almost-extinct disease. In the Horn of Africa, there are now 121 reported polio cases. Last year, there were 223 worldwide.

Siddharth Chatterjee has served as the chief diplomat, head of strategic partnerships and international relations at the International Federation of the Red Cross and Red Crescent Societies, the world’s largest humanitarian network, since June 2011.

Photo Courtesy of Siddharth Chatterjee.

In his previous work with UNICEF, Chatterjee was on the front lines of polio eradication campaigns in South Sudan, Darfur and Somalia, and remains passionate about the eradication of polio and the advancement of child rights.

Excerpts from his conversation with Anna Shen follow.

Q: Considering all the attention given to fighting polio, what are the causes of these outbreaks now?

A: When the Global Polio Eradication Initiative (GPEI) was launched in 1988, the poliovirus was in 125 countries, paralysing or killing 1,000 people a day. Today, polio cases have been reduced by 99 percent with only 223 cases reported worldwide in 2012.

The GPEI Independent Monitoring Board recently remarked that, ‘Poliovirus has been knocked down but it is certainly not knocked out.’

Outbreaks happen when large populations of children are not immunised. This can happen for a couple of reasons, including operational quality of campaigns, but most often because insecurity, like the recent violence in Pakistan, or mobile populations make children inaccessible.

Ultimately, to stop this outbreak, we need to hammer the virus continuously with vaccines and repeated rounds of immunisation, and find ways of accessing the hard to reach and insecure areas.

Q: What is the biggest obstacle to the eradication of polio and how do you overcome it?

A: Myths and misinformation, high illiteracy, extreme poverty, weak health systems, insecurity and poor infrastructure represent real challenges to vaccination efforts and the overall expansion of access to health care.

I saw this firsthand in 2005 when I was working with UNICEF in Somalia. After two years without a case, polio returned and paralysed 228 children. Herculean efforts were made to ramp up social mobilisation, intensive and wide-scale response activities, overcoming huge security and logistical challenges and massive funding helped in stopping the spread.

Through the Somali Red Crescent we were able to access some of the most insecure areas.

Government leadership, trusted national institutions, social mobilisation, engagement and negotiating with all parties is key to any successful campaign. This was my experience in Darfur too. In insecure areas we have to talk to everyone, each party regardless of their political or ideological position is a stakeholder and we have to get everyone aligned around one central theme-children and their wellbeing.

Q: Why is the focus on polio alone, and what is the international community doing to stop other vaccine-preventable diseases?

A: The world has made an enormous amount of progress against a whole range of vaccine-preventable diseases over the past few years. The GAVI Alliance – a public-private partnership focused on increasing access to vaccines in low-income countries – has contributed to the immunisation of more than 370 million children since 2000. Dr. Seth Berkley, the CEO of GAVI, is leading the charge to ensure a quarter of a billion children are vaccinated by 2015.

The greatest legacy of the polio eradication movement might very well be the foundation for stronger health systems it creates along the way. The polio programme is already finding and reaching previously inaccessible children with the polio vaccine and combining these efforts with other health care resources.

We’re building a system that can increase access not only to vaccines, but to other medicines, bed nets for malaria prevention, clean water, access to proper sanitation, hygiene promotion, improved nutrition, reproductive health services, etc.

Q: Has the international community done enough?

A: The international community has been awesome, and frankly without their support we would not have got this far in our fight against polio.

At the end of April 2013, I was at the Global Vaccine Summit in Abu Dhabi. Leaders attending this meeting signaled their confidence in GPEI’s Strategic Plan. Together, they committed four billion dollars, close to three quarters of the plan’s 5.5-billion-dollar cost over the next six years.

Led by Mr. Bill Gates, chairman of the Bill and Melinda Gates Foundation, and the Crown Prince of Abu Dhabi, along with Rotary International, UK, U.S., Australia, and EU among others, joined to renew their commitment to end polio forever. We saw new partners like the Islamic Development Bank join the fight against polio.

Q: What is the end game that will complete polio eradication and how can the IFRC help?

A: After decades of foreign aid, national investments and philanthropic giving that has produced an impressive record of results, we need a decisive win.

The GPEI’s Polio Eradication and Endgame Strategic Plan 2013–2018, launched earlier this year, sets out a clear framework to not only interrupt the transmission of wild poliovirus, but to introduce a dose of inactivated polio vaccine – or IPV – into routine immunisation programmes globally to simultaneously eliminate the risk vaccine-derived poliovirus.

IFRC reach spans the global to the local. With 187 National Societies, and nearly 100 million staff, volunteers and members, I believe every child can be reached by the Red Cross Red Crescent National Societies. Our volunteers speak the language, live in these communities, engage with community leaders. Our National Societies are trusted at the grassroots, everywhere.

Q: The GPEI Update of Partners’ Report describes you as one of the global influentials and you have been writing a lot about polio eradication. What about this issue compels you the most?

A: I have seen distraught mothers crying inconsolably after their children contracted polio. Many were paralysed and many died. It is really heartbreaking. I have also seen many young people who survived were crippled for life, helpless and their lives a living hell.

And for me, it’s personal: I survived polio and I was very lucky. In fact, many thousands of children in India contracted polio in the not-so-distant past and were forced into lives of infirmity and despondency because of poverty, ignorance, and poor access to health services.

I would certainly want to see this disease eradicated forever. This would be the greatest gift we can give to all children in the world.

Excerpt:

A mother waits for her baby to be vaccinated at the Bugurundi Clinic in Dar es Salaam, Tanzania. Credit: Kristin Palitza/IPS

By Kristin Palitza
DAR ES SALAAM, Dec 22 2012 (IPS)

A nurse working in a remote clinic in Mueda, a small town in northern Mozambique’s Makonde Plateau, receives a shipment of vaccines from the national health department. Using special software on her mobile phone, she sends out a mass text message to alert mothers in the area about the availability of immunisations.

She also uses the phone to schedule appointments, access patient records and order new vaccines when stock runs low.

It is – for now – a theoretical scenario on how mobile technology can help improve childhood immunisation in sub-Saharan Africa. But it will soon become a reality in Mozambique, a country the size of Turkey, where 135 out of 1,000 children die before their fifth birthday.

The southern African nation’s Department of Health has teamed up with the GAVI Alliance, a public-private partnership for immunisation, to launch a pilot project in about 100 clinics in early 2013 where health workers will test the effectiveness and cost benefits of using mobile phones to communicate with patients.

The yearlong three-million-dollar pilot project has been co-financed by British telecommunications giant Vodafone and the United Kingdom’s Department for International Development. At the end of the trial, vaccination levels in Mozambique should improve by five to 10 percent, the donors say.

“One thousand new mobile broadband connections are made every minute in the developing world, which means we have a tremendous opportunity to transform lives in an easily accessible way,” explains U.K. Secretary of State for International Development Justine Greening.

Africa is the world’s fastest-growing mobile phone market and the second largest after Asia, according to Groupe Speciale Mobile Association, a global industry body. There are about 700 million mobile connections on the continent and the number of mobile phone users increased by nearly 20 percent every year over the last five years.

Although not every mother in the poor nation of Mozambique, which according to United Nations statistics had a meagre gross national income per capita of 382 dollars in 2009, has a mobile phone, at least one family member or a neighbour usually does.

As part of the pilot project caregivers will be registered on a health ministry database and will be educated and alerted by text message about the availability of vaccines and their importance. They can reply via SMS to schedule clinic appointments and will receive notifications and reminders about their children’s past and future vaccinations to make sure each child receives a full immunisation schedule.

Mozambique’s health workers will receive smartphones with software to access records and schedule appointments and help clinics in remote locations monitor stocks to make sure vaccines are available when mothers arrive with their children.

“Mobile technology will help us identify children who until now have been missed and make sure they get a full set of vaccinations,” GAVI CEO Seth Berkley tells IPS. The ability to notify and remind mothers of vaccination appointments is expected to make a big dent in high drop-off rates, where a child receives only one out of two or three necessary injections to make a vaccine effective, he says.

According to the World Health Organization (WHO), immunisation is the most cost-effective public health intervention after the provision of clean water. More than a million children die each year from vaccine-preventable diseases, while every fifth child in Africa remains unimmunised, the organisation says.

A number of other African nations have started to use mobile technology in some areas of public health care, although the Mozambican pilot project will be the most comprehensive when it comes to immunisation and will use software specifically developed for national conditions and needs.

Tanzania, for example, uses mobile stock management technology to track malaria treatments in 5,000 clinics across the country. In South Africa, 1,800 remote community health workers use mobile phones to access and update patient records. And when Ghana rolled out rotavirus and pneumococcal vaccines this April, a major local religious organisation helped notify mothers about the new immunisations by arranging for 1.5 million SMS messages to be sent out.

South Sudan, supported by the WHO, began to manage vaccine stocks through mobile technology in mid-2012 in its central and state stores, while Rwanda’s health ministry uses mobile phones to monitor maternal and child mortality.

“The cell phone has been revolutionising (African) healthcare more than any other technology,” Richard Sezibera, Rwanda’s former minister of health and current secretary-general of the East African Community, tells IPS.

Providing health workers with mobile devices “has really changed life in Rwanda,” he adds. The strategy has helped bring down Rwanda’s under-five mortality rate from 163 per 1,000 live births in 1990 to 56 per 1,000 live births in 2011, according to U.N. Children’s Fund figures.

Sezibera also believes that using mobile technology can help health departments to better manage their usually meagre budgets. Since most African nations only spend an average of five percent of GDP on health, “how we finance health is becoming increasingly important,” he says. “Using mobile technology can help reduce supply chain and transaction costs.”

If Mozambique’s pilot project is successful, it will be expanded to 1,500 clinics across the country. If that works well, GAVI hopes to implement it in many other low-income countries in sub-Saharan Africa, Berkley says.

Civil society organisations, which have been working to improve child health in those countries for years, believe the approach could make a huge difference to children’s lives.

“We know the children in remote areas are missing out (on being vaccinated), with 22 million around the world being left behind,” says Justin Forsyth, CEO of the international charity Save the Children. That is every fifth child. “Mobile technology, in the hands of front line health workers, could help close the gap.”

A three-day polio vaccination campaign kicked off throughout Darfur on Feb. 28, 2011 as part of the Sudanese Government's efforts to eradicate the disease. Credit: UN Photo/Olivier Chassot

By Siddharth Chatterjee and Dr. Sam Agbo
UNITED NATIONS, Oct 6 2012 (IPS)

It was early July 2004, and Darfur was looking like a war zone – massive human displacements of an estimated one million people, ongoing skirmishes, inclement weather, a parched landscape due to the recurring droughts, and sheer misery everywhere.

The worst affected were women and children. Each passing day, the agony and suffering we witnessed was heartbreaking. There was an urgent need to quickly immunise all children in Sudan, and this included Darfur, to prevent polio, a life-threatening and crippling disease, which loomed ominously on the horizon.

In June 2004, the Global Polio Eradication Initiative (GPEI) led by WHO, Rotary International, U.S. Centres for Disease Control and UNICEF warned that the polio virus was spreading at an alarming rate across West and Central Africa. In May 2004, it was confirmed that a child was paralysed by polio in Darfur.

This was a complex emergency; a simmering conflict, combined with hunger, malnutrition, lack of access to clean water, sanitation, health and other basic services made survival itself a challenge.

It was in these circumstances that UNICEF and WHO in Sudan along with important NGO partners started planning with local authorities on how best to immunise all children in Darfur. Saving lives and mitigating the suffering of these affected populations scattered over the three states in Darfur was included in a joint response plan that was being developed.

The overarching issues remained addressing the rights and the humanitarian needs of vulnerable populations and groups, irrespective of their political status or differences. Most importantly, it was about giving children and their mothers the best possible start in life, building their resilience and addressing their basic needs, despite the enormous challenges around them.

Challenges and issues

Safety of all staff, international and local was paramount. The local rebel factions that were operating in Darfur refused to allow vaccinators to enter the areas they controlled. The ongoing conflict, absence of infrastructure, lack of adequate cold storage and the very high temperatures all posed formidable challenges for vaccination.

In order for the immunisation campaign to succeed, we needed to include all stakeholders in the planning process, especially to reach out to and involve the various rebel factions, who controlled many parts of areas inaccessible to our staff.

Actions and the way forward

With full knowledge of government counterparts, talks were initiated with the leadership of the different rebel groups. From the senior-most political leaders to the local commanders in the field, it was important to get everyone aligned on the importance of this initiative, as it was about the children in the areas they controlled or communities they came from.

Following active engagement, negotiation and persuasion with the Sudanese government and non-state entities (rebel groups), a window of two weeks of cessation of hostilities was secured from all parties. Large numbers of staff were mobilised by WHO, UNICEF and the NGO partners to help with the campaign.

This allowed multi-agency teams the opportunity to conduct a rapid assessment of previously inaccessible areas and develop a micro-plan for a ‘Polio plus’ campaign (polio vaccines with de-worming tablets and Vitamin A supplements) to improve child health and minimise under five-year-old mortality.

More than 10,000 children under five years of age were reached in the rebel-controlled areas during the two vaccination rounds. Education and health kits were provided to these communities as part of the campaign in order to address the educational and health needs of children in the communities as well as provide a sense of normalcy under the very stressful conditions they lived in.

At least 10 skilled staff in the recipient populations were trained to provide care and support. This was combined with a mass campaign of hygiene promotion with simple messages on hand washing and waste disposal to prevent diarrheal diseases.

The polio immunisation campaign was the driver for a wider process of improving and ramping up assistance to communities and this made the campaign attractive to mothers to bring their children to the immunisation hubs that were established.

To overcome some of the challenges of very poor infrastructure, large numbers of donkeys and camels were hired to ferry supplies, including cool boxes, to remote communities. The U.N.’s World Food Programme also assisted the initiative by providing helicopters which helped reach some of the most remote areas.

The Global Polio Eradication Initiative (GPEI) had served as a bridge, an entry point and a disease control strategy for reaching the unreached and most vulnerable. The lesson learned is that it is possible to immunise children even in complex emergencies and conflict settings.

Embracing the principles of neutrality, humanity and independence is fundamental to the success of these approaches, and willingness to negotiate with all parties is paramount.

Forging partnerships with national institutions like the Red Cross and Red Crescent national societies, guided by their Fundamental Principles and auxiliary to their governments, has helped to scale up polio eradication programmes exponentially. As per GPEI, “In 1988 when the campaign began there were 125 countries where polio rages, today there are three.”

Finally, a critical aspect for success was not being risk-averse. The humanitarian imperative became the driver for social mobilisation and action to prevent polio. This campaign gave us an opportunity to not just scale up the immunisation programme but allowed us to address issues around child survival in Darfur.

With resolve, leadership at global and country level, partnerships, commitment and alacrity, it is possible to eradicate polio forever everywhere, and soon. And health services may well serve as a bridge for peace in conflicts.

*Siddharth Chatterjee is the Chief Diplomat and Head of Strategic Partnerships at the International Federation of Red Cross and Red Crescent Societies. He can be followed on Twitter at sidchat1. Dr. Sam Agbo is an independent public health advisor in the UK.