A polio vaccinator administers the oral polio vaccine to a child in Pakistan. Credit: Ashfaq Yusufzai/IPS

By Ifeanyi Nsofor
ABUJA, Jun 22 2022 (IPS)

For forty days, Kunle Adeyanju – a Nigerian, Rotarian, polio eradication advocate and biker – rode for more than 12,500km from London to Lagos to raise funds for polio eradication.

Adeyanju documented his journey on Twitter, where his handle is appropriately named @lionheart1759. Indeed, it takes one with a lion’s heart to embark on such a bold adventure. People like philanthropist Bill Gates, who works on polio eradication, and the CEO of Twitter, Parag Agrawal, tweeted out their support and admiration.

Even in the face of dwindling resources and competing demands, the push for the total eradication of polio must continue because as long as even a few people have polio, it could spread widely again

I also followed Adeyanju’s journey on Twitter, and I applaud him too, including because I love to see individuals pursue their dreams, no matter how terrifying it seems. Ellen Johnson Sirleaf, Africa’s first female President and former President of Liberia, aptly captures this sentiment, “The size of your dreams must always exceed your current capacity to achieve them. If your dreams do not scare you, they are not big enough.”

I also support his cause. Polio is a serious infectious disease – it causes paralysis of muscles and also kills if the respiratory muscles are affected. In the past, polio victims who were unable to breathe on their own were placed in iron lung machines to enable them to breathe. Thanks to the efficacy of the polio vaccine, this is now history.

I am a proud alumnus of polio eradication. It was my first experience in global health. As a young monitoring, evaluation and surveillance officer at Nigeria’s National Programme on Immunization, I was involved in the global polio reaction initiative supporting advocacy, training of health workers and supervising routine and polio vaccinations across Nigeria.

We’ve seen in recent years how the global community has come a long way in almost making polio the second infectious disease (after smallpox) to be eradicated. Without a doubt, Rotary International has been a major partner and funder on this journey. I am part of the Rotary International family and was the president of the Rotaract Club at the Nnamdi Azikiwe University College of Medicine, Nnewi, southeast Nigeria. Rotary International launched a global polio vaccination campaign in 1985.

Three years later, the Global Polio Eradication Initiative (GPEI) was established. At that time, polio paralysed more than 1000 children globally daily. Since then, more than 2.5 billion children have been immunized against polio. Consequently, global incidence of polio cases has decreased by 99%. Currently, wild poliovirus continues to circulate in Afghanistan and Pakistan. Nigeria interrupted polio transmission in 2019.

Even in the face of dwindling resources and competing demands, the push for the total eradication of polio must continue because as long as even a few people have polio, it could spread widely again. The final five-year push to eradicate polio would cost an estimated less than $1 billion per year.

Like Adeyanju, Gates, and others, I want to see polio completely eradicated. These are four areas where those $5 billion funds could make that possible.

First, polio vaccine is needed to vaccinate all eligible children. To be fully protected for life, children need four doses of polio vaccines. Polio vaccines come in two forms – oral and injectable. Based on UNICEF estimates, cost per fully vaccinated child is $0.42 for oral polio vaccine. In contrast, it is $2.78 for an injectable polio vaccine.

Second, polio surveillance is a continuous process necessary for prevention and detection of the virus. The polio virus is passed out in stool. That’s why polio transmission is faeco-oral.

This makes polio transmission common in communities with poor sanitation and widespread public stooling. Surveillance activities involve collecting and screening stools of children who have quick onset paralysis after episodes of fever. Further, environmental surveillance of polio involves collecting and testing sewage water for the polio virus.

Third, vaccine storage via modern cold chain equipment. Maintaining the right cold chain for vaccines requires constant electricity, which is lacking across communities in sub-Saharan Africa. For example, only 48% of sub-Saharan Africa has access to electricity, according to the World Bank.

Therefore, clean renewable energy such as solar is a sustainable way to provide the right cold chain for vaccines. Across African countries, some primary health centers already use solar freezers for vaccine storage. Solar freezers don’t come cheap. A Solar Direct Drive Freezer sold on the African Union’s “Africa Medical Supplies Platform” costs $5,797.56.

Lastly, public health education is imperative to achieve equity in complete polio eradication and to continue to see successful vaccination campaigns in countries without polio. Indeed, the University of Global Health Equity, Rwanda captures this succinctly, “to achieve equity in healthcare, depends on equity in health education”.

Polio education is delivered in communities using community health workers, community leaders and community based organisations. Other means include use of radio, TV, print media and electronic media. More polio education should be delivered via social media. Adeyanju has made polio topical among youths on social media by following his heart and pursuing his dream

Adeyanju’s bold ride from London to Lagos has put polio on the front burners of international discourse, especially in these times of covidization of everything.

Through his action, he has answered in the affirmative Rotary International’s four-way test of what people say, think or do:

Is it the truth? – Yes

Is it fair to all concerned? – Yes

Will it build good will and better friendships? – Yes

Will it be beneficial to all concerned? – Yes

Thank you, Kunle Adeyanju. Your boldness will save lives and stop children from being paralysed. You are a hero.

Dr. Ifeanyi McWilliams Nsofor is a graduate of the Liverpool School of Tropical Medicine. He is a Senior New Voices Fellow at the Aspen Institute and a Senior Atlantic Fellow for Health Equity at George Washington University.

Authorities in North Waziristan district in Pakistan, vaccinate children against polio. With one case reported, intensified efforts to eradicate the disease are underway. Credit: Ashfaq Yusufzai/IPS

By Ashfaq Yusufzai
PESHAWAR, Pakistan, May 12 2022 (IPS)

Pakistan’s North Waziristan district authorities have launched an aggressive vaccination drive after a polio case surfaced after 15 polio-free months in the country.

The disease was detected in a 15-month-old toddler about 15 kilometers away from the Afghanistan border. This area was considered a Taliban militant’s hub until 2014.

The Taliban were against polio vaccinations, but immunization drives restarted after the militants were evicted in 2014.

The boy’s family says he had been vaccinated.

“The boy has been vaccinated in every door-to-door polio vaccination campaign, but even then, he developed the crippling disease. We aren’t opposed to polio drops,” says Naheedullah, the toddler’s uncle. “We are religious people but never defied vaccination.”

However, the authorities dispute the family’s version and say the newly infected child hadn’t received oral polio vaccines (OPV) because his family was among those they call “silent refusals”.

“Silent refusals are those whose families argue that their children below five years have been inoculated, but they remain unvaccinated,” Dr Shamsur Rehman, a health official in the region, told IPS. In Khyber Pakhtunkhwa, 18,349 children remain unvaccinated due to refusal by their families during the March 2022 campaign. This is down from 19,874 recorded in December 2021.

Vaccinators also face threats from the defiant parents – and as a result, often record the children as vaccinated to stay safe from reprisals. More than 50 people have been killed, allegedly by militants, since 2012 in various anti-polio drives, mainly in Khyber Pakhtunkhwa, which remained a hotspot of the virus for many years, Pakistan’s oldest newspaper Dawn reported.

Religious scholar Muhammad Sami says polio vaccines aren’t allowed in Islam, and therefore, there is polio vaccine hesitancy. He said his group had “information” that the vaccination was a plot to “render the recipients incapable of producing children and cut down the population of the Muslims.”

However, others in the same area have a different opinion.

“We have been persuading parents to administer OPV to their kids as it is their religious responsibility to protect their offspring from diseases,” says Maulana Sagheer, adding that it was false information that the vaccines caused sterility and infertility.

Zulfiqar Babakhel, spokesperson for Pakistan Polio Programme, told IPS that the detection of this latest case of wild poliovirus wasn’t unexpected.  The Pakistan programme had anticipated this risk and put in place contingency plans to enable a rapid response, he said.

It continues to intensify its efforts to eradicate all remaining residual transmission of any strain of poliovirus.

“The ‘last mile’ has always proven to be the toughest phase of national eradication efforts in all countries. Although challenges remain, the programme is capitalizing on the momentum of recent success and continues to strive for zero-polio. This is the most critical time for the programme,” Babakhel said.

It is important to emphasize that the number of polio cases has been significantly reduced this year due to health workers’ unwavering commitment and communities’ and various stakeholders’ support, he said.

It is the third case of wild polio to be reported globally in 2022. Others were reported from Afghanistan and Malawi.

Pakistan had reported one case last year with onset on January 27, 2021, in Killa Abdullah district, Balochistan province.

Health Secretary Dr Aamir Ashraf told IPS that this was a tragedy for the child and his family. It is also regrettable both for Pakistan and polio eradication efforts worldwide.

“We are disappointed but stay undeterred. The case appeared in Southern Khyber Pakhtunkhwa where the poliovirus was detected late last year and where an emergency action plan is already being implemented,” he says.

“The National and Provincial Polio Emergency Operations Centres have deployed teams to conduct a full investigation of the recent case, while emergency immunization campaigns are underway to prevent further spread of the wild poliovirus in Pakistan,” he says.

Repeated immunizations have protected millions of children from polio, allowing almost all countries to become polio-free, besides the two endemic countries of Pakistan and Afghanistan.

The next sub-national Polio vaccination campaign, expected from 23 – 27 May 2022, will target over 24 million under-five children.

The polio programme had identified Khyber-Pakhtunkhwa as the area most at risk after wild poliovirus was detected in environmental samples in the last quarter of 2021.

“This validates the programme’s concerns about virus circulation in Southern KP and strengthens our resolve to reach every child with the polio vaccine,” said the National Emergency Operations Centre (NEOC) coordinator for polio, Dr Shahzad Baig.

To address the challenges in Southern KP, the Government and global polio partners had already initiated an emergency action plan to address the challenges in this part of the province, he explained.

In 2020, the province of Khyber-Pakhtunkhwa reported 22 cases, while no wild poliovirus cases were recorded in the area last year.

Substantial progress has been made recently, with most areas accessible to implement immunization campaigns, but deep-rooted problems and security concerns remain in a few places. Despite the challenges, the programme’s frontline workers continue to reach children with the life-saving vaccine.

The programme is capitalizing on the momentum gained last year and continues to strive for zero-polio. Parents must continue to vaccinate their children during every immunization round until they reach the age of five.

Pakistan remains one of only two countries globally with circulating wild poliovirus, together with Afghanistan. Polio is a highly infectious virus. Until this last epidemiological block wipes out polio, children worldwide remain at risk of life-long paralysis or fatality by the poliovirus.

IPS UN Bureau Report

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A child is vaccinated against the poliovirus. Malawi detected a single case and embarked on a mass vaccination programme against the disease which causes paralysis. Credit: Charles Mpaka/IPS

By Charles Mpaka
Blantyre, Malawi, Apr 18 2022 (IPS)

One polio case is one too many, global health experts say.

And when Malawi announced in February this year that it had detected a polio case in the country’s capital Lilongwe, the alarm was significant, and the response from both the government and global health partners was swift, if not frantic.

Detected on a 3-year-old child, the poliovirus is described by experts as a significant public health concern for several reasons.

According to the World Health Organisation (WHO), polio has no cure, and it is a highly infectious disease.

“It invades the nervous system and can cause total paralysis within hours,” said WHO in a statement released on February 17, 2022, upon the Malawi Government’s announcement of the outbreak.

Furthermore, Malawi has not registered any cases of polio in 30 years. The country last reported a case of poliovirus in 1992.

In 2005, Malawi obtained a polio-free status.

The WHO further says that the last case of wild poliovirus in Africa was detected in northern Nigeria in 2016. Globally, there were only five cases of wild poliovirus recorded in 2021.

In addition, according to the United Nations health body, Africa was declared free of indigenous wild polio in August 2020 after eliminating all forms of wild polio.

To date, says WHO, polio remains endemic in Afghanistan and Pakistan, and laboratory test results on the case in Malawi showed that the strain was linked to the one found in Pakistan’s Sindh Province.

“As long as wild polio exists anywhere in the world, all countries remain at risk of importation of the virus,” Dr Matshidiso Moeti, WHO Regional Director for Africa, said upon the announcement.

Immediately after the outbreak, the government declared a Public Health Emergency.

It also instituted risk assessment and surveillance measures to contain any potential spread of the virus – but it assured that there was no evidence that the poliovirus was circulating in the community. There are no reports of additional cases of polio thus far.

Within 72 hours, the Global Polio Eradication Initiative (GPEI) Rapid Response Team arrived in the country to support the outbreak response.

These efforts were followed by a mass vaccination campaign, the first of four rounds, targeting 2.9 million children under five.

UNICEF procured 6.9 million polio vaccine doses for exercise.

UNICEF had partnered with WHO and the Global Polio Eradication Initiative’s Gavi, Bill and Melinda Gates Foundation, Rotary and Centers for Disease Control and Prevention in supporting the Ministry of Health to vaccinate children in four mass campaigns.

The phase ran from March 21 to 26, 2022.

A Poliovirus Outbreak Response Situation Report released by the government on April 4 says 2.97 million children aged between 0 – and 59 months had been vaccinated in the campaign, representing 102 percent administrative coverage.

The Ministry of Health says it is delighted with the campaign’s success.

“We attribute this to the dedicated workforce, the door-to-door approach and low presence of misconceptions, misinformation and disinformation surrounding polio vaccine,” the ministry’s spokesperson, Adrian Chikumbe, told IPS.

But the campaign was affected by some challenges, the Ministry of Health acknowledges in the vaccination campaign review report.

Malawi is reeling from the impacts of cyclones Ana and Gome, which hit the country in January this year, leading to flooding in many parts of the country and displacement of close to a million people. According to the report, the dispersion of the communities due to flooding increased the workload for vaccination teams.

“Polio campaigns with house-to-house strategy have not been conducted in-country in more than ten years, resulting in house-to-house vaccination not being strictly being followed in some areas. Grassroot social mobilisation was also delayed in some communities,” adds the report.

The second phase of the polio vaccination campaign is slated for late April.

“We urge all of us to sustain the gains in the first round of the campaign by making sure no eligible child is left behind in the subsequent rounds of the campaign. That way, our children will be adequately protected against polio which leads to paralysis or even death,” says Chikumbe.

UNICEF says the re-emergence of the wild poliovirus in Malawi, three decades after it was last detected, is “cause for serious concern”.

“Vaccination is the only way to protect the children of Malawi from this crippling disease which is highly infectious,” says UNICEF representative in Malawi, Rudolf Schwenk.

According to UNICEF, as an epidemic-prone, highly contagious disease, polio can spread easily through the movement of people from endemic to polio-free areas.

This polio vaccination campaign comes nine months after Malawi also administered another polio vaccination drive in July last year when the country undertook a week-long catch-up campaign that targeted 1.8 million children who missed the vaccine earlier.

Ministry of Health says the vaccination campaign last year was intended to immunise all children born after the world had switched from the Trivalent Oral Polio Vaccine (tOPV) to the Bivalent Oral Polio Vaccine (bOPV). The bOPV is said to protect children against all three types of polioviruses.

Community health activist Maziko Matemba tells IPS that one case of polio is one too many because of the high rate of spread of the virus and the severity of its effects.

“You need a rapid response to forestall its spread. You may not manage it if it slips through, so immunisation is key,” says Matemba, also executive director for Health and Rights Education Programme (HREP), a local non-governmental organisation.

But he says the re-emergence of the case after 30 years in Malawi should remind the government of the need to ensure the health system’s resilience.

He says this resilience can be achieved through adequate funding to the health sector.

“As a country, we need to ensure that our health system is resilient and robust. One way we can make it such is by meeting the Abuja Declaration on Health to allocate at least 15 percent of the national budget to the health sector.

“Twenty-one years after that declaration, we still can’t go past 10 percent in budget allocation to the health sector. Without sufficient funding, outbreaks of this nature can spiral out of control, and we will struggle to contain other health shocks,” Matemba says.

Since the last case in 1992, Malawi has sustained its polio surveillance through an independent committee of experts that oversees and coordinates the country’s polio monitoring and reporting system.

IPS UN Bureau Report

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A Pakistani child receives a dose of the oral polio vaccine (OPV). Credit: Ashfaq Yusufzai/IPS

By Matshidiso Moeti
BRAZZAVILLE, Mar 22 2022 (IPS)

In the outskirts of Malawi’s capital, Lilongwe, just beyond where paved roads transition to dirt, an undiagnosed polio infection paralysed a three-year-old girl. From one day to the next, the child’s life was changed forever.

Among Africa’s public health community, we had looked at our successes against wild poliovirus as a cause for optimism. In the 1990s, the disease paralysed more than 75,000 African children every year. But following extensive immunization campaigns coupled with strong surveillance, the wild poliovirus was officially kicked out of sub-Saharan Africa just under two years ago.

We went from 300,000 cases in 1985 to zero in 2020, just as the COVID-19 pandemic struck. In Malawi, there had been no case of wild poliovirus since 1992, and for many, the disease had become a distant memory.

The four-month suspension of polio vaccination campaigns in more than 30 countries in 2020, coupled with related disruptions to essential immunization services, led to tens of millions of children missing polio vaccines. Including the three-year old girl in Malawi who is now paralysed for life

Polio is a viral infection that causes nerve damage and, in some cases, paralysis that can lead to permanent disability or even death. It is transmitted mostly through contaminated water or food, and its symptoms—fever, sore throat, headaches, pain in the arms and legs—are so generic that an active infection is often difficult to diagnose until paralysis strikes.

While polio remains endemic to Afghanistan and Pakistan, with a few dozen cases identified every year in each country, it has been eradicated just about everywhere else. The Americas were declared polio-free in 1994; China, Australia, and the Western Pacific countries in 2000, Europe in 2002; and Southeast Asia in 2011. The last cases in Africa were in Nigeria, in 2016, in the north of the country where the horrors of armed conflict had upended immunization efforts.

But over the past two years, the COVID-19 pandemic has disrupted efforts to combat vaccine-preventable diseases, including polio, in many other places. The four-month suspension of polio vaccination campaigns in more than 30 countries in 2020, coupled with related disruptions to essential immunization services, led to tens of millions of children missing polio vaccines. Including the three-year old girl in Malawi who is now paralysed for life.

We know a lot about wild poliovirus now, enough to trace the case in Malawi to a strain of the virus originating in Pakistan. While this new detection does not affect the African region’s wild poliovirus-free certification status, it has set the world back in its efforts to eradicate the disease.

And if transmission is not stopped within the next 12 months, the continent’s certification status would likely be revisited. This disease creates far too much devastation, on a personal and health system level, for us to allow that to happen.

We can detect the presence of the virus, along with its genetic origins, through sampling urban sewers—and so we have launched surveillance efforts in Lilongwe and cities in neighbouring countries. We’ve also deployed healthcare workers to go door-to-door in Malawi, identifying families whose children have unexplained paralysis, and securing samples for testing to see if polio was the cause.

With support from international and local partners, governments in the region have now launched an intensive immunization campaign, with the intent of vaccinating more than 23 million children in Malawi and its neighbours Tanzania, Zambia and Mozambique, as well as Zimbabwe.

The vaccine needs to be administered in multiple doses, so the logistics of reaching out to both urban and rural locations, with trained staff who carry sufficient numbers of doses, has to be well planned and executed. Luckily, we are benefiting from lessons learned from experiences in Syria and Somalia in recent years, where the polio programme quickly stopped the spread of imported wild poliovirus, despite challenges posed by on-going conflict and insecurity.

Dr Matshidiso Moeti, World Health Organization Regional Director for Africa

It was no coincidence that the African Region achieved its wild polio-free status two years ago. This only happened because of the decades of commitment by governments, communities and partners, and we are now leveraging the wealth of experience and expertise we have built in the region to move quickly to bring this outbreak under control.

The payoff is immense. Globally, eradication efforts have saved the lives of an estimated 180,000 people and spared an estimated 1.8 million children from disability. The economic benefit for ending polio have been projected at upwards of US$50 billion by 2035, with the vast majority of these benefits accruing to low-income countries freed from having to handle such a terrible health threat.

Eliminating polio is about more than an economic stimulus, of course. We do it because it is a source of suffering that we can remove from this world, because every child paralysed by a polio infection is one child too many. Wild poliovirus cases around the world are at an all-time low, and we have a historic opportunity to stop the transmission of the virus for good.

To achieve this, we need governments throughout Africa—especially the southern nations—to join these efforts, step up surveillance, vaccinate their children, and get back on track to wipe this virus off the planet.

Excerpt:

A polio vaccinator administers the oral polio vaccine to a child in Pakistan. The country remains one of three in the world where polio is yet to be eradicated. Credit: Zofeen T. Ebrahim/IPS

By Zofeen Ebrahim
KARACHI, Pakistan, Mar 11 2020 (IPS)

Dr. Rana Muhammad Safdar, the coordinator for Pakistan’s National Emergency Operations Centre for Polio Eradication, has sleepless nights thinking about what needs to be done for his country to eradicate polio.

“Not only me but the entire team is having sleepless nights thinking how best and how quickly we can reach the finish line,” he told IPS. “It’s always painful to hear a child getting paralysed for life from a vaccine-preventable disease.”

Last month, over 39 million children under the age of five were vaccinated across Pakistan. And a little more than 180,000 children were missed because their parents refused to have them vaccinated. While the number of missed children is marginal in comparison to those who were vaccinated, it has caused concern.

“The proportion of children missed in the last two campaigns due to refusals is very small (0.5 percent) but where clustered these can still provide the virus with the opportunity to survive longer and re-infect areas that we clean through so much hard work,” Safdar lamented.

The Pakistan Polio Eradication Programme began 26 years ago with the “largest surveillance network” in the world — an army of 260,000 polio vaccinators going door to door to administer oral polio vaccine (OPV) to children under five. Yet the country is only one of three in the world, along with Afghanistan and Nigeria (Nigeria has not reported any wild polio virus cases for a year, however there have been cases of vaccine-derived poliovirus in the West African nation), that has not eradicated the virus.

Last year, for the first time, Pakistan reported 25 positive Wild Poliovirus 1 (WPV1) cases across the country. Since the start of the year 23 new cases have been reported, with more expected to be recorded later this year.

The issue is so sensitive that every small gain by anti-vaccine groups takes the vaccination campaign two giant steps back. A video shared on Twitter last year, claiming that polio drops had some toxic ingredient making children sick, went viral and led to a round of refusals for months afterwards.

The reason for refusals include the same misconceptions that vaccination teams have been facing the past several years and include unfounded beliefs that; the programme is a western-funded campaign with some hidden agenda, polio drops are given to Muslim children to cause infertility and to stem the population of the Muslim community, it has some ingredients that are forbidden for Muslims, and that it causes paralysis.

Abrar Khan, a 29-year-old teacher, contracted polio when was just three. He’s no public health specialist, but Khan has an encyclopedia of knowledge about the virus. Five years ago he was a polio ambassador with the government’s Polio Eradication Initiative.

And he still makes it a point to visit homes in his locality of Baldia Town, in Karachi’s District West, that are marked by polio workers with an “R” because the family refused to have their children vaccinated. “I tell them it is their right to refuse; I try and convince them but even if they say yes to me, I have no way of knowing if they got their child vaccinated,” he told IPS in a phone interview.

He said people were more concerned about the other more common diseases their children where battling with, as well as the failing healthcare system. “One way to win these people over would be to provide better quality healthcare,” said Khan.

Swaleha Ahmed*, who asked for her real name not to printed because she holds a senior position within the polio programme, told IPS that if the government were to provide for the needs of young children, including paying for their healthcare, education and basic needs, “all those parents who hide their kids when polio workers visit their homes will come forward and get their kids registered to avail this childcare fund”. 

Ahmed, who has been with the programme for some 17 years, pointed out that because the campaign was so old, complacency has set in. And as parents continue to refuse to all their children to vaccinated, it was discovered that some vaccinators in Khyber Pakhtunkhwa (KP), where the virus originated and is circulating, were wrongly marking refusals as having been vaccinated.

“It happened in KP in the very remote areas where these workers have to walk miles in knee deep snow only to be told by families that they do not want their kids to be administered drops,” she said.

But the programme is trying to overcome this.

“We are telling polio workers that if they get refusals, it will not make a dent on their daily wages nor will they have to go again as someone else will be sent in their place if they face resistance,” said Ahmed. “They are also warned that if they are found to fake the process and mark the kids without first giving them drops, they can lose their jobs.”

But there is growing fatigue for this campaign from the side of parents as well. Nasik Abbas,who works as a supervisor in Tarnol, some 20 km from the federal capital, Islamabad, has been involved in the polio campaign for over 13 years. “Parents are now annoyed by the regular knocking at their door,” he told IPS.

Hifza Tahir, who works in Islamabad’s Bahria Town has been facing another dilemma. “They turn me away saying they will get their kids vaccinated from the hospital.”   

Ahmed said the working hours and ways of working for polio vaccinators, some 62 percent of whom are women, needed to be reevaluated.

“We should not bind these workers by time and attendance. We are dealing with kids and their parents. So we should give the workers flexi times in which they must cover the required number of homes,” said Ahmed. In some cases, she said, it would make more sense to visit the house later in the day when the decision maker, usually a father, was home from work, or early morning before the kids went to school. 

Ahmed, however, admitted that despite the challenges the polio programme has come a long way. “Today, the polio workers are better trained to deal with parents, have an ID card to prove their identity, are provided security and everything is documented,” she said.

The campaigns will continue with another round of special vaccination in high risk districts this month followed by a nationwide campaign in mid-April, said Safdar.

“Our efforts from December 2019 till April 2020 will push the virus back to 2017-18 levels and from thereon we will further push it towards zero polio by focusing on routine immunisation, improving basic health services, malnutrition as well as ensuring safe water and sanitation,” he said.

A Pakistani child receives a dose of the oral polio vaccine (OPV). Credit: Ashfaq Yusufzai/IPS

By External Source
UNITED NATIONS, Oct 25 2019 (IPS)

In a “historic achievement for humanity”, two of three wild poliovirus strains have been eliminated worldwide, the World Health Organization (WHO) announced on Thursday, following the conclusion by a group of experts that WPV3, type three of the disease, has been eradicated completely.

The deadly viral disease is “very close” to disappearing altogether, with the number of affected children having dropped by 99 per cent since 1988, the UN Children’s Fund (UNICEF) announced on World Polio Day, marked each 24 October, positioning the world closer than ever to its total eradication.

Afghanistan and Pakistan are the two remaining countries with reported cases, with Nigeria, a third polio-endemic country, having gone three years without a reported infection, placing it on track to be certified polio-free by 2020.

“Following the eradication of smallpox and wild poliovirus type two, this news represents a historic achievement for humanity”, WHO said, with only type one of the virus remaining.

18 million would have been paralyzed

All three strains are symptomatically identical, WHO explains, causing irreversible paralysis, and in cases when muscles become immobilized, the disease leads to death. Early on, other signs may include fever, fatigue, and stiffness in the neck and limbs, though most infected people (90 per cent) have very mild, or no symptoms at all.

Thanks to disease control efforts, including the Global Polio Eradication Initiative (GPEI), comprised of WHO, UNICEF and other health partners, 18 million people are currently walking, who otherwise would have been paralyzed by the virus.

In addition, milestone polio eradication work has saved the world more than $27 billion in health costs in the last 30 years, with potential to generate $14 billion in cumulative cost savings by 2050, when compared to costs incurred in controlling the virus indefinitely.

Beyond Thursday’s milestone, eradication “will send a strong message” regarding the power of vaccines at a time when public trust has been undermined, WHO has said.

As the world faces a spread of misinformation over vaccine safety, eliminating polio will provide “irrefutable evidence” that they work.

UNICEF has stressed that seeing polio disappear means every child, in every household must continue to be vaccinated. The agency has managed to distribute over one billion doses annually, but thousands of children are still missing out.

Vulnerable children live in remote areas or in conflict-affected communities, making access a challenge. Marginalized and underserved communities, already lacking basic resources like water and health care, sometimes only received care through targeted polio vaccination campaigns.

UNICEF continues to lead efforts to increase acceptance and demand for the vaccine through community dialogue, trust-building and evidence-based communication on the effectiveness of the immunization.

This story was originally published by UN News

Credit: ©UNICEFKENYA/2011/MODOLA

By Rudi Eggers and Werner Schultink
NAIROBI, Jan 20 2017 (IPS)

For a long time, no person in Kenya suffered the devastating disability that is caused by polio. In fact, the only reminder in the early 2000s was the victims in the streets of Nairobi, many of whom had been paralyzed as children and adults. Their lives were ravaged by this terrible, vaccine-preventable disease.

A five-day polio campaign that started on 18 January, 2017 targets more than 2.9 million children below the age of 5 years in fifteen counties. Children in high-risk areas -- some of whom have never had access to immunization services before -- will have an opportunity to be vaccinated against polio.
Sadly, in 2013 a large outbreak of polio in Nigeria spread across the continent, affecting several countries on its way east. Kenya was not spared.  Fourteen new polio cases were confirmed. The polio virus struck those that were unvaccinated – the most vulnerable and the most excluded — children in areas with poor access to health services, refugees, and nomadic communities.  Fortunately, a rapid response by the Kenyan Government brought the polio outbreak under control, and the last case was reported in July 2013.  At that time, it seemed that the country was well on the road to being declared polio-free.

However, recently, concerned scientists have pointed to the increasing risk of polio, particularly the large numbers of children who remain unvaccinated, especially those in vulnerable populations in the northern part of the country and in the informal settlements of Nairobi and Mombasa.  Furthermore, the notion that the African continent was free from the polio virus was shattered when four new polio cases were reported in northern Nigeria. Given the previous experience, health experts and Ministries of Health recommended that the areas with low vaccination rates should be targeted with vaccination campaigns, specifically designed to reach those that missed out on the routine vaccinations.

Since the establishment of the Expanded Programme of Immunization (EPI) in 1980, Kenya deserves credit for reaching majority of the children with life-saving vaccines. But there is still a lot more work that needs to be done; progress in the country is very uneven and many children remain unvaccinated. It is estimated that 400,000 (3 out of 10) children still do not receive all the required scheduled doses of vaccines by their first birthday. This build-up of under-immunized children has previously contributed to outbreaks of polio. Most of these children come from poor families, the urban informal settlements and the hard-to-reach parts of the country, particularly arid and semi-arid (ASAL) regions where access to health services is limited.

A child receives vaccination against polio in a Mother and Child Health (MCH) Clinic at Mukuru Health Centre, in Nairobi, Kenya. Credit: ©UNICEFKENYA/2016/NOORANI

As long as there is a child out there who has contracted this disease, no matter where they live or who they are – all children everywhere are not safe. The four cases confirmed in October 2016 in the current polio outbreak in Nigeria place other African countries, including Kenya, at risk of importing the wild polio virus, due to the unaccounted number of unvaccinated children across the continent as well as the high population movement.

In the final push towards eradicating polio by 2018, Kenya with its strict monitoring system for the safety and quality assurance of vaccines, has already proved that it has the capacity to make the whole country polio-free. A five-day polio campaign that started on 18 January, 2017 targets more than 2.9 million children below the age of 5 years in the fifteen counties of Bungoma, Busia, Garissa, Isiolo, Lamu, Mandera, Marsabit, Nairobi, Samburu, Tana River, Trans Nzoia, Turkana, Wajir, West Pokot and Uasin Gishu. Children in high-risk areas — some of whom have never had access to immunization services before — will have an opportunity to be vaccinated against polio.

To ensure that all vulnerable children are reached, the exercise will be relying on the steadfast commitment of vaccination teams and the communities they serve. These heroic women and men in most cases walk long distances from house-to-house, often in the most dangerous of circumstances to reach all children. Communities where the polio campaign is backed and encouraged by religious and community leaders have much higher rates of protection than those that lack this support.

As part of the worldwide campaign to eradicate polio, there is need for everyone to rally behind this polio vaccination campaign, to reach each and every child regardless of their geographical location of their status in society. We have a responsibility to protect hundreds of thousands of children in Kenya from being paralyzed for life; from being excluded from their communities; and from being denied their right to a full and productive life.

In 2017 and beyond, no child in Kenya should suffer the consequences of a vaccine-preventable disease, for every child deserves to live in a polio-free world.

Excerpt:

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.

A Pakistani child receives a dose of the oral polio vaccine (OPV). According to the WHO, Pakistan is responsible for 80 percent of polio cases worldwide. Credit: Ashfaq Yusufzai/IPS

By IPS Correspondents
KATHMANDU/PESHAWAR, Pakistan, Oct 24 2014 (IPS)

The goal is an ambitious one – to deliver a polio-free world by 2018. Towards this end, the multi-sector Global Polio Eradication Initiative (GPEI) is bringing out the big guns, sparing no expense to ensure that “every last child” is immunised against the crippling disease.

Home to 1.8 billion people, roughly a quarter of the world’s population, Southeast Asia was declared polio-free earlier this year, its 11 countries – Bangladesh, Bhutan, Democratic People’s Republic of Korea, India, Indonesia, Maldives, Myanmar, Nepal, Sri Lanka, Thailand and Timor-Leste – joining the ranks of those nations that live without the polio burden.

United in the goal of eradicating polio, an infectious viral disease that invades the nervous system and can result in paralysis within hours, governments across the region worked hand in hand with community workers, NGOs and advocates to make the dream a reality.

“Pakistan has the highest [number of polio cases] among the three endemic countries worldwide." -- Elias Durry, emergency coordinator for polio eradication with the WHO in Pakistan
According to GPEI, immunisation drives reached some 7.5 billion children over the course of 17 years, not just in city centres but also in remote rural outposts. During that time, the region witnessed some 189 nationwide campaigns that delivered over 13 billion doses of the oral polio vaccine (OPV).

High-performing countries like Sri Lanka, the Maldives and Bhutan eradicated polio a decade-and-a-half ago while India, once considered a stubborn hotbed for the disease, clocked its last case in January 2011, thus bringing about the much-awaited regional ‘polio-free’ tag.

But further north, dark clouds in the shapes of Afghanistan and Pakistan blight Asia’s happy tale. Together with Nigeria, these two nations are blocking global efforts to mark 2018 as polio’s last year on this planet.

Celebrating success from Nepal to the Philippines

For countries like Nepal, home to 27 million people, the prevalence of polio in other nations in the Asian region threatens its hard-won gains in stamping out the disease.

“There’s always fear that polio may see a resurgence as the disease hasn’t been eradicated everywhere,” said Shyam Raj Upreti, chief of the immunisation section of Nepal’s child health division (CDH).

Anxious to hold on to the coveted polio-free status, Nepal recently introduced the inactivated injectable polio vaccine (IPV) into its routine immunisation programme, the first country in South Asia to do so.

“While the oral polio vaccine has been the primary tool in polio eradication efforts, new evidence shows that adding one dose of IPV – given to children of 14 weeks by intramuscular injection – to the OPV [schedule], will maximise immunity to poliovirus,” Upreti explained.

He credits his country’s success to a high degree of social acceptance of the importance of child health in overall national development. “Female health volunteers play a key role in making the community understand why immunisation is important,” he said, adding that these volunteers provide services to some of the poorest segments of the population.

Between 1984 and 2011, Nepal’s immunisation coverage more than doubled from 44 to 90 percent. Ashish KC, child health specialist at UNICEF-Nepal, said that immunisation programmes didn’t stop even during the ‘people’s war’, a brutal conflict between the Maoists and the Nepali state that lasted a decade and killed 13,000 people.

“We understood that [we] needed a multi-sector approach, so service delivery was decentralised, and access was made easier,” KC told IPS. “Immunisation went beyond health, it became a part of [our] development plans.”

Such a mindset is also apparent in the Philippines, where the government recently decided to include the IPV into its national health plan, making it the largest developing country to do so.

According to a press release by Sanofi Pasteur, the multinational pharmaceutical company working closely with the Philippine government on its eradication initiatives, many Filipinos feel deeply about polio, having had a prime minister who was a survivor of the disease and lived with lifelong disabilities as a result.

“What’s striking about the Philippines is how strong a partnership there is around vaccinations,” said Mike Watson, vice president of vaccinations and advocacy at Sanofi Pasteur, referring to the unprecedented support shown by government officials and civil society at an event in Manila earlier this month that ended with several children receiving the IPV, the first of some two million children who will now be vaccinated every year.

“Getting the vaccine out to distribution centres on the smaller islands obviously poses a logistical challenge, but the Philippines has proven it’s really good at that,” Watson told IPS.

He added that strong networks of community health workers have enabled the Philippines to move into the “endgame”, the last stage in global eradication efforts that will require the 120 countries that aren’t currently using the IPV to introduce it by the end of 2016, representing one of the biggest and fastest vaccine introductions in history.

Over 5,700 km away from the Philippines, however, lives the lingering threat of polio, with thousands of children still at risk, and hundreds suffering from the debilitating results of the disease.

Pakistan’s polio troubles

This past June, the World Health Organisation (WHO) recommended a travel ban on all those leaving Pakistan without proof of immunisation, in a bid to prevent the spread of polio outside the country’s troubled borders.

But absent swift political action, travel bans alone will not staunch the epidemic.

A 2012 Taliban-imposed ban on the OPV has effectively prevented over 800,000 children from being immunised in two years, health officials told IPS.

In 2014 alone, Pakistan has recorded 206 cases of paralysis due to wild poliovirus, the most savage strain of the disease. Last week, 19 new cases of this strain were brought to the attention of the authorities.

“Pakistan has the highest [number of cases] among the three endemic countries worldwide,” Elias Durry, emergency coordinator for polio eradication with the WHO in Pakistan, told IPS.

The situation is most severe in the northern tribal areas, where the Taliban has used both violence and terror to spread the message that OPV is a ploy by Western governments to sterilise the Muslim population.

“The militancy-racked Federally Administered Tribal Areas (FATA) accounts for 138 cases, while the adjacent Khyber Pakhtunkhwa (KP) province has 43 cases,” Pervez Kamal, director of health in FATA, told IPS.

North Waziristan Agency has registered 69 cases, while the Khyber Agency and South Waziristan Agency are struggling with 49 and 17 cases respectively.

In a tragic development, an 18-month-old baby girl named Shakira Bibi has become the latest in a long line of polio victims. Her father, Shoiab Shah, told IPS that “Taliban militants” were responsible for depriving his daughter of the OPV.

In an unexpected twist, a military offensive aimed at breaking the Taliban’s hold over northern Pakistan has given health officials rare access to hundreds of thousands of residents in the tribal areas.

With close to a million people from North Waziristan Agency fleeing airstrikes and taking refuge in the neighbouring KP province, community health workers have been delivering the vaccine to residents of displacement camps in cities like Bannu and Lakki Marwat.

Still, this is only a tiny step towards overcoming the crisis.

Altaf Bosan, head of Pakistan’s national vaccination programme, said 34 million children under the age of five are in need of the vaccine but in 2014 alone “about 500,000 children missed their doses due to refusals by parents to [defy] the Taliban’s ban.”

The government has now elicited support from religious leaders to convince parents to submit to the OPV programme.

“Islamic scholars from Pakistan, Saudi Arabia, Egypt [and] Afghanistan have issued a fatwa [edict], reminding parents that it is their Islamic duty to protect their children against disease,” Maulana Israr ul Haq, one of the signatories, told IPS.

According to the WHO, Pakistan is responsible for nearly 80 percent of polio cases reported globally, posing a massive threat to worldwide eradication efforts.

Excerpt:

Former cricket captain Imran Khan administers oral polio vaccine to children in Akora Khattak in Khyber Pakhtunkhwa province of Pakistan. Credit: Ashfaq Yusufzai/IPS.

By Ashfaq Yusufzai
PESHAWAR, Pakistan, Jan 3 2014 (IPS)

The Taliban are proving to be a huge stumbling block for Pakistan as the South Asian nation – one of only three remaining polio endemic countries in the world – tries to fight the crippling disease.

Not even top Islamic scholars have been able to make a dent as militants continue to kill polio workers, and ask parents not to vaccinate their children.

The Taliban are hampering vaccination work in all provinces, say health workers. The situation is particularly grave in Khyber Pakhtunkhwa and the Federally Administered Tribal Areas (FATA) in the north of Pakistan.“On the one hand they claim to promote Islam, on the other they defy Islamic scholars."

“It is a matter of concern that the Taliban carry on despite the decrees issued by religious scholars in favour of vaccination,” Maulana Samiul Haq, chancellor of the Darul Uloom Haqqania, one of Pakistan’s biggest madrassas or Islamic seminaries, told IPS.

He too had issued a decree a month earlier, calling upon parents to vaccinate children against poliomyelitis and prevent disability. The disease is infectious and mainly affects children under five.

“We appeal to the Taliban to stop killing polio workers for the sake of our children,” said Haq, who inaugurated an anti-polio campaign along with cricketer-turned-politician Imran Khan in December in Khyber Pakhtunkhwa province.

“The notion that the oral polio vaccine (OPV) is a ploy by the U.S. to reduce the population of Muslims is incorrect,” said Haq.

Of Pakistan’s 35 million children, 80,000 remain unimmunised, according to Dr Elias Durry, chief of the World Health Organisation (WHO) Pakistan polio eradication campaign. This is mostly due to the refusal to administer vaccine by parents suspicious of it due to socio-cultural reasons.

In Khyber Pakhtunkhwa, which has a population of 22 million, about 22,000 children have not been vaccinated. Many parents believe OPV is harmful. And the Taliban have only made things worse.

Taliban militants have killed 17 people in polio-related incidents in the province from December 2012 to December 2013, and continue to block vaccination.

Khyber Pakhtunkhwa recorded 10 of the 76 new polio cases in Pakistan in 2013, while Sindh and Punjab provinces reported seven and six cases respectively.

In FATA adjoining Khyber Pakhtunkhwa, the Taliban has banned vaccination since June 2012. Of the 53 new cases in FATA, North Waziristan Agency alone recorded 26.

Polio officer Dr Anwar Ali says the situation has gone from bad to worse because there is no let-up in Taliban’s attacks on polio workers.

An international conference of religious scholars in Islamabad in June had declared that those killing polio workers were infidels. The edict bore signatures of top religious scholars from Pakistan, Egypt, Afghanistan and Saudi Arabia.

But it hasn’t helped.

Ali said the attacks on polio workers have escalated. The Taliban continue to deprive children of much-need vaccination.

In March 2013, three Pakistani religious scholars – Maulana Tahir Ashrafi, Maulana Samiul Haq and Maulana Hanif Jalandhri – were sent to Cairo to seek information about OPV in a religious context. Since their return, they have been trying to persuade the Taliban to allow vaccination, but to no avail.

The United Nations Children’s Fund (UNICEF), which supports the government’s polio immunisation efforts, has brought out a booklet containing nearly 40 religious decrees supporting vaccination so as to make parents administer polio drops.

“People can be convinced about vaccination if the Taliban accepts religious decrees in favour of OPV,” Ali said.

Maulana Muhammad Nabi, a Peshawar-based cleric, points out that the Taliban attack polio workers as well as the policemen protecting them.

“It is a matter of grave concern that the Taliban disregard edicts issued by acclaimed scholars about the effectiveness and legality of OPV,” he said.

“On the one hand they claim to promote Islam, on the other they defy Islamic scholars. Islam asks its followers to protect children from diseases. It is the basic responsibility of parents to ensure the good health of their children.”

Not only do the Taliban expose children to disease, but also bring Islam into disrepute by refusing to allow vaccination, Nabi said.

“Unimmunised children pose a threat to other children. The Taliban should honour the Islamic decrees to protect children from polio.”

While preaching against vaccination in Waziristan Agency in FATA, the Taliban had said it was an American tool to spy on them. They argued that the U.S. ran a vaccination campaign through Dr Shakil Afridi to trap and kill Osama bin Laden in Abbottabad in 2011.

Mufti Muhammad Mushtaq says he had issued decrees asking his disciples to promote vaccination, but many polio workers had left the campaign due to fear of the Taliban.

The Taliban have killed five polio workers in Mardan, a district in Khyber Pakhtunkhwa. “Despite my decree, some 6,000 children remain unvaccinated in Mardan,” he said.

Dr Muzam Khan, an immunisation officer in FATA, believes decrees will not boost the fight against polio as long as the Taliban don’t support vaccination.

“In 2012, we had 22,000 refusals, and in 2013 the number of refusals went up to 28,000. The Taliban are unlikely to pay any heed to the decrees.”

Israr Madani of the NGO International Council for Religious Affairs (ICRA) said, “We have been working with madrassa publications to understand the extent of the Taliban’s influence on vaccination and the role of decrees.

“We are going to publish literature in the light of Islamic teachings that can be used to create acceptance for vaccination.”

The danger lies in the polio virus spreading from Pakistan, which is the only other polio endemic country in the world besides Nigeria and Afghanistan. “Recently, a virus strain from Pakistan was detected in Egypt,” Madani said.

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:

Families and health workers defy the Taliban's ban on oral polio vaccines (OPV). Credit: Ashfaq Yusufzai/IPS

By Ashfaq Yusufzai
PESHAWAR, Pakistan , Jul 11 2013 (IPS)

Four-year-old Muhammad Jihad is handicapped, and his parents know who to blame: the Taliban.

Jihad’s father, Muhammad Rishad, says the boy tested positive for polio on May 6 at the National Institute of Health in Islamabad.

The family had travelled from their home in North Waziristan, a mountainous region that comprises part of Pakistan’s Federally Administered Tribal Areas (FATA), to ensure their son had the best possible care, only to be told that the virus had spread too far, and little Muhammad would likely never walk again.

"The Taliban are enemies of children. They are against education and vaccination, both of which are necessary for a child’s development.” -- Noor Gul, a schoolteacher in northern Pakistan
A distraught Rishad told IPS, “The Taliban militants are responsible for my son’s (paralysis) – they placed a ban on the oral polio vaccine, so my son could never get immunised.”

Rishad is a daily wage-labourer, who had few dreams beyond securing a decent life for his only son. Now, he says, the Taliban have robbed him of his little hope for the future.

“When he grows up, my son will condemn the militants,” Rishad added, even though such thoughts bring him little solace.

Experts here say children are the future of this troubled country of 170 million, and should be protected at all costs.

Sadly, such advice has fallen on deaf ears in the militancy-ridden northern regions, where the Taliban have imposed a complete ban on all vaccines against preventable childhood diseases, including polio – sometimes referred to simply as “infantile paralysis” due to its crippling effects on a child’s nervous system – measles, diphtheria, hepatitis, meningitis, pertussis, influenza and pneumonia.

Children in all seven agencies of FATA have been the worst affected by the ban on the oral polio vaccination (OPV), which the Taliban have described as a ploy by the United States to render the Muslim population infertile. Over 160,000 children in North Waziristan and 157,000 children in South Waziristan are now at risk of contracting deadly ailments.

The Taliban have used violence and terror to implement the ban – since December 2012 at least 20 volunteer health workers and policemen have been assassinated for daring to defy the militants’ orders by participating in immunisation drives in the Khyber Pakhtunkhwa (KP) and Sindh provinces.

Two years ago, polio had been wiped out in all but three countries worldwide: Afghanistan, Nigeria and Pakistan. In Pakistan, the recent recurrence of the disease marks several steps back from successful attempts at eradication: from just 28 cases in 2005, the country saw a rapid increase of up to 117 cases in 2008, and 198 cases in 2011.

Eighteen cases have already been reported in 2013, and experts fear that number could rise very quickly.

Dr. Farman Ali, based at the Agency Headquarters Hospital in the town of Miranshah in North Waziristan, told IPS “an outbreak of polio” is never far off when large numbers of children remain unimmunised while the virus is in circulation.

According to the Health Department, medical workers have recorded over 50,000 incidents of families refusing the vaccination in FATA and the KP.

“The Taliban have strictly warned us to stay away from vaccination. They have broken the iceboxes of health workers and threatened to kill them if they (continue their work),” Ali said.

Taliban Spokesman Ihsanullah Ihsan told IPS last year that his “leadership decided to ban the vaccine because it was an excuse for the U.S. to send in its spies and expose Taliban leaders to drone strikes…we will allow vaccination when the U.S. stops its drone strikes.”

But rather than the U.S. government, it is poor families who are paying the price for this ban.

Gul Daraz, a resident of North Waziristan Agency, has a three-year-old son who had already received his first dose of the OPV when the ban was announced. Because he was never allowed to complete the full course of three doses, as required by the World Health Organisation, he is now handicapped.

“Every time my wife sees our crippled son, it reduces her to tears,” Daraz, a poor shopkeeper, told IPS.

Sadly they are not alone in their plight. According to FATA Health Director Dr. Fawad Khan, “We have only been able to vaccinate 400,000 of the 900,000 target children under five years in FATA.”

He told IPS 58 cases were reported across the country last year, including 27 in KP and 20 in FATA, of which 12 of the victims had been prevented from receiving the OPV.

Zareen Taja, a housewife in FATA’s Bajaur Agency, told IPS over the phone, “My son is very beautiful, but he will not be able to walk like normal people. I have no one to blame but the Taliban.”

At this rate, she added, Pakistan will never achieve its goal of eradicating this preventable disease that has been stamped out in all but two other countries in the world.

Noor Gul, a schoolteacher in the Frontier Region Bannu, whose son is one of the two affected children in the province, labeled the Taliban “enemies of children”.

“They are against education and vaccination, both of which are necessary for a child’s development.”

An international conference of Islamic scholars held on Jun. 6 in the capital, Islamabad, condemned Taliban militants for killing Pakistani polio workers, and held them responsible for the resurgence of the disease.

Dr. Muhammad Wesam, chief scholar of Al-Azhar University in Cairo, told conference participants that the Taliban’s campaign “contravenes Islam”.

Thirty-four scholars from Pakistan, Yemen, Egypt and Saudi Arabia issued a decree saying that those impeding vaccination efforts were committing a crime, for which God would hold them accountable.

Such interventions by clerics are crucial to correcting the misconception that OPV is “anti-Islamic”. Dr. Jan Baz Afridi, head of the KP immunisation programme, told IPS his office is working with religious scholars and volunteer health workers to continue vaccination drives.

“We are under tremendous pressure to immunise all 5.2 million children in the KP in order to effectively wipe out the disease,” he added.

The Ukraine is facing a “real threat” of a return of polio as well as outbreaks of other serious diseases such as mumps, rubella and measles because of a combination of state inefficiency and public mistrust of vaccinations, health experts have said.

The country has one of the lowest vaccine coverage rates in Europe, especially among children, and cases of some preventable diseases have soared in recent years.

International health officials say they are working with the Ukrainian authorities to improve immunisation rates, but fear that there could be major disease outbreaks in the future and lives endangered unless progress is made on raising vaccination rates.

“There is a very real risk that polio could return and that there could be outbreaks of other disease, such as mumps and rubella. Unless coverage, which is now at a 20-year low in the Ukraine, is improved we can only expect further outbreaks in the future,” Dr Dorit Nitzan, World Health Organisation representative in the Ukraine, told IPS.

Vaccination rates in the Ukraine have plunged since 2008 following an incident in which a teenage boy died after he received a jab for measles and rubella.“There is a very real risk that polio could return and that there could be outbreaks of other disease, such as mumps and rubella."

The boy’s death was wrongly reported as being caused by the vaccine and an initial confused government response and the arrest of the country’s chief medical officer in what critics say was a purely political move left many people fearful over the safety of vaccinations.

This fear remains ingrained in many today. A recent survey by UNICEF showed that a third of Ukrainian parents are against immunisations.

Vaccination rates among children are particularly low. Although national health guidelines state that children should be vaccinated against 10 infectious diseases, including polio, rubella, whooping cough and measles, only 50 percent are fully immunised. This is down from 80 percent in 2008, according to UNICEF.

Olga Denisova, a 33-year-old sales assistant from Kiev, told IPS that she had had her adolescent daughter vaccinated, but was very worried about the safety of vaccinations.

“As a mother of course I am worried. I hear so many stories about vaccines not being safe that it is hard not to be concerned. People don’t have enough information about vaccination and the government should be telling them more about it,” she said.

“I know that because of the low vaccination rates there might be cases of polio here. That scares me. I think it is obvious that if myself and other mothers are worried about vaccines that there is something wrong with the whole vaccination process.”

Child vaccinations are not enforced by law but children are not allowed to start school without certificates showing that they have been vaccinated. Parents get round this by obtaining fake documents.

These fears are also, perhaps surprisingly, being reinforced by local healthcare workers.

Many of them take an at best apathetic, and at worst dismissive, approach to vaccines.

“We are working to try and get medical staff to actively promote vaccinations,” Dr Nitzan told IPS.

She said that many remained worried that, as happened to doctors in the case of the death of the immunised boy in 2008, they could find themselves punished or arrested if someone had an adverse reaction to a vaccine.

While the World Health Organisation (WHO) and the United Nations Children’s Fund (UNICEF) and some prominent Ukrainian physicians have been keen to make the public aware of the safety and importance of immunisation, it is not uncommon to find doctors claiming that vaccinations are harmful.

Even when people do want to be vaccinated, they are not always able to have it.

Immunisation is free under state health care but hospitals often run out of stocks for months at a time.

Some mothers have told local media of facing a ten-month wait at their local clinics for the vaccine their child needs. While some resolve the situation by paying out of their own pocket at a pharmacy, not all parents in a country where the average monthly wage is 300 euros can afford to do so.

The shortages at hospitals are put down to a mix of underfinancing, inefficient vaccine procurement procedures and corruption.

The state budget is under pressure, with the economy having struggled desperately since the 2008 financial crisis. The government says it has funding for around 65 percent of the nation’s vaccine needs.

Procurement processes for vaccines have also been widely criticised as inefficient with poor forecasting leading to problems with supplies.

Meanwhile, allegations of corruption in vaccine tender processes – leading to inflated prices being paid for vaccines by the health ministry and subsequently less vaccines available – are made frequently. UNDP officials have previously told Ukrainian media that “private interest in vaccine tenders” was behind vaccine shortages.

All these problems combined have left the Ukraine facing a serious health challenge, the WHO says.

An outbreak of polio – a disease almost completely eradicated from Europe – is of particular concern. Only 74 percent of the population is immunised against it compared to average rates in Europe and the U.S. of more than 90 percent. Because of the threat of an outbreak, the WHO last month led a polio simulation exercise in the Ukraine.

The WHO is hopeful that the situation can be improved.

“What’s needed is better procurement mechanisms, improved capacities, better reporting, for example proper investigations after adverse events, and of course an information campaign to build trust with the public,” Nitzan told IPS.

“We are hopeful though. The new Ukrainian health minister, Raisa Bogatyrova, is committed to not just public health in general but to vaccines specifically. We can only hope that there is cross-sector support from the other ministries involved in health in the Ukraine, such as the finance ministry, and progress (on improving vaccination coverage) can be made.”

The Agency Headquarters Hospital (AHH) in Bajaur Agency, shortly after a Taliban suicide bomb attack. Credit: Ashfaq Yusufzai/IPS

By Ashfaq Yusufzai
PESHAWAR, May 1 2013 (IPS)

Akbar Shah was sitting with his sick wife in the gynaecology ward of the Agency Headquarters Hospital in Bajaur Agency, a division of northern Pakistan’s Federally Administered Tribal Areas (FATA), when a bomb ripped through the facility, scattering patients, doctors and medical supplies.

“We immediately rushed my wife to Peshawar (capital of the neighbouring Khyber Pakhtunkhwa province) because the doctors, paramedics and nurses were panicked and unable to look after patients,” Shah told IPS.

Hours later, the Taliban claimed responsibility for the Apr. 20 suicide mission.

"The Taliban are just inviting the wrath of God Almighty by targeting healthcare facilities...The patients should be shown mercy."
Shah’s wife is now being treated in a hospital in Peshawar and though her condition is showing signs of improvement, Shah still curses the Taliban for its ruthless campaign against health facilities in the region.

The entire medical community, along with a large majority of the general public, has slammed this latest attack, which killed four people, as a plot to deprive FATA’s population of six million people of adequate healthcare.

According to Dr. Shaukat Ali at the FATA Health Directorate, the 200-bed Agency Headquarters Hospital (AHH) had provided treatment to over 100,000 patients annually, with the help of 120 doctors and 100 paramedics.

“It is the only specialised hospital in FATA,” he told IPS, but it is now devoid of both patients and doctors, who have fled to Peshawar.

With 26 hospitals, 10 rural health centres and 419 community health centres, FATA is well equipped to deal with all of its residents’ medical needs. But if the attacks do not stop immediately, Shaukat Ali warned, the entire health system here will be rendered ineffective.

Meanwhile, medical facilities in Peshawar are struggling to keep pace with the influx of patients from tribal areas on the Afghanistan border, who say they are “too afraid” to visit hospitals that might be targeted by militants.

Dr Ahmad Sher at the Khyber Teaching Hospital in Peshawar told IPS his facility received about 20,000 patients from FATA in 2012 alone.

“The Taliban are just inviting the wrath of God Almighty by targeting healthcare facilities where patients are treated for different ailments. The patients should be shown mercy,” he said.

So far the Taliban have destroyed about 400 health facilities in FATA and the Khyber Pakhtunkwa (KP) province.

“Since 2008, the Taliban militants have damaged 128 health facilities in FATA,” Secretary of the Provincial Doctors Association (PDA) Dr. Muhammad Irfan told IPS, while the adjacent KP lost 55 health facilities between 2007 and 2009, during the Taliban’s illegal rule over the Swat district.

Militants have been particularly unforgiving of those who defy the so-called “ban” on polio immunisation, which they have labeled “un-Islamic”. The group also claims the oral polio vaccine (OPV) was designed to render the recipients impotent and infertile in order to “curb” population growth of Muslims.

In the past three months the Taliban have claimed responsibility for the deaths of 17 policemen, female vaccinators and volunteers in polio-related violence.

Last year, out of a total of 58 cases of polio in the country, 27 were recorded in the KP and 20 in FATA, which experts believe is likely the result of the Taliban’s interference with immunisation drives.

Fathema Murtaza, Pakistan spokeswoman for Doctors Without Borders (known by its French acronym MSF) told IPS it is crucial that medical structures and patients be spared from violence.

“MSF…calls for respect for the safety and security of patients, health facilities, and medical staff,” the group said in a press release last week. “All actors in the area must ensure that medical activities can take place unhindered and not be targeted.”

Since March, MSF medical teams have been running mobile clinics in Bajaur, providing services in three Basic Healthcare Units (BHUs) where about 200 patients are treated every week, Murtaza said.

“The safety and security of healthcare is essential for MSF to continue to expand its medical intervention in Bajaur,” she added.

The PDA’s Dr. Muhammad Irfan condemned the Taliban and asked the government to tighten security on hospitals so patients can receive necessary treatment undisturbed.

“We will hire private security guards and will impart training to our watchmen and other staff on how to foil terror (plots),” FATA’s director of health, Dr. Fawad Khan, informed IPS.

In that same vein, the female staff of government-run hospitals will be trained on how to conduct body searches of female visitors and take appropriate measures if they encounter anything suspicious.

The health directorate has also sought the services of the KP police in the training of health personnel.

Like other experts and medical professionals here, Khan believes the targeting of health facilities is particularly egregious in a region that is already lagging behind global health indicators, particularly with regards to maternal mortality.

“About 365 women (per 100,000 live births) die every year in Pakistan’s four provinces, while in FATA the number is closer to 400 due to pregnancy-related complications,” he said.

Similarly, FATA only has a 40 percent immunisation rate, compared to a nationwide rate of 67 percent.

A majority of FATA’s 400 qualified doctors are too afraid to go to work because of the dangers that loom over them every day, he added.

(END)

A child is vaccinated for polio outside Peshawar, Pakistan. Credit: Ashfaq Yusufzai/IPS

By Katelyn Fossett
WASHINGTON, Apr 9 2013 (IPS)

A U.S.-based civil society coalition is calling on Congress and President Barack Obama’s administration to keep spending on global health aid at current levels, warning that recent budget cuts risk a dangerous backslide in health and development gains achieved over the past three decades.

The new brief has been published by InterAction, a Washington-based umbrella of international NGOs, is supported by 37 organisations. It warns that any future cuts to these programmes would endanger important health milestones achieved in part due to U.S. assistance.We have a choice: we can invest now or pay forever.

These include the near-eradication of polio and the treatment of over five million people living with HIV/AIDS. In addition, the brief warns that austerity-related budget cuts that went into effect on Mar. 1 could lead to the re-emergence or worsening of critical global health threats, like those posed by the spread of malaria and tuberculosis.

“The U.S. is at a critical juncture in its global health efforts: budget pressures threaten the global health gains that have been made and jeopardize programming … Capitalizing on our successes and meeting emerging global health challenges will require increased and sustained commitments by all donors,” the brief says.

But the warning is competing with snowballing enthusiasm for budget-cutting that has seized Washington since the recent cuts, known here as the “sequester”, went into effect. Cutting roughly five percent of all federal budgets, analysts say the sequester would slice around 433 million dollars from U.S. global health aid for the remainder of this fiscal year alone.

The United States is the world’s largest individual donor to a spectrum of global health initiatives.

“We see the brief as a resource for members of Congress and their staff on U.S. investments in global health,” Danielle Heiberg, one of the authors of the brief, told IPS. “By highlighting how current and past U.S. investments have made significant progress in global health, we hope that Congress will understand the value and importance of maintaining appropriate funding for the global health accounts.”

“Sustained US investments in global health programs and health systems strengthening are crucial – health problems will only be more expensive and more difficult to resolve in the future, especially with the rise of non-communicable diseases (cancer, lung and heart-disease and diabetes) in all populations,” the brief says.

Sequester-related cuts have been forced to impact on nearly all federal programmes, with Congress purposefully designing them so that neither policymakers nor agency heads could target the reductions at waste or initiatives of low priority. Critics note that foreign aid generally only constitutes about one percent of the U.S.’s total budget – with just a tenth of that for global health.

Nonetheless, U.S. spending still has an outsized impact on global health projects. Indeed, the United States has taken on an even more expanded role since the 2008 financial crisis led other donor countries to cut their aid programmes.

Newly released data from the Organisation for Economic Co-operation and Development (OECD), a grouping of rich, industrialised countries, has revealed a 5.4-billion-dollar decline in general international aid flows worldwide in the past year.

Advocates have expressed particular concern about the future of U.S. health assistance because it does not have the deep political support that bolsters other kinds of foreign developmental assistance. Projects for which mutual economic opportunities for donor and recipient countries are far more visible – such as improving infrastructure or trade, for instance – tend to benefit from deeper political support than that for health aid.

“Domestic donor interests have much more influence in donor capitals where aid decisions are being made,” Gregory Adams, head of the aid effectiveness programme at Oxfam International, a humanitarian group, told IPS. “The more locally owned and demand-driven aid gets cut first.”

Adams listed the Global Fund to Fight Aids, Tuberculosis, and Malaria, an international financing organisation, as one of the groups that is affected by this decision-making bias.

Indeed, on Monday the Global Fund announced a massive new 15-billion-dollar fundraising goal. If it attains this goal, the group says it will be able to prevent a million new HIV infections and save the lives of almost six million people with tuberculosis.

“We have a choice: we can invest now or pay forever,” Mark Dybul, executive director of the Global Fund, said Monday. “Innovations in science and implementation have given us a historic opportunity to completely control these diseases. If we do not, the long-term costs will be staggering.”

Double problem

Oxfam’s Adams further warns that there is a “double problem” with foreign aid.

“It’s not just that the [aid] is not getting to the people who need it, but you take these countries that trusted the United States and give them reason not to trust the U.S,” he said.

“We keep asking partner countries to show more leadership – to do a better job of leading and meeting their own countries’ needs, but sometimes the global donor country makes it very difficult for those countries to plan their leadership by changing the goal posts.”

In addition, failure to follow through on health assistance could introduce the additional obstacles of reduced immunity and new drug-resistant strains of a disease, particularly with malaria and tuberculosis.

“History shows that if we scale back funding, malaria will re-emerge worse than ever, especially since populations with reduced immunity will face an increase in morbidity,” the InterAction brief states.

In March, the World Health Organisation issued a statement on the increasing spread of drug-resistant tuberculosis, a growing public health crisis due in part to its history of incomplete treatments in developing countries. A study in August 2012 found that almost half of TB patients were not responsive to either first- or second-line treatments, suggesting the disease could become “virtually untreatable”.

For now, health and aid groups are expressing fear, uncertainty and a fair amount of outrage as they wait to feel the concrete effects of the March cuts.

“The sequester is going to have a significant and detrimental effect,” Oxfam’s Adams said. “[But] it’s a blunt instrument – it’s hard to predict how the axe is going to fall.”

Families of the deceased health workers mourn the loss of their loved ones in Karachi. Credit: Adil Siddiqi/IPS

By Ashfaq Yusufzai and Zofeen Ebrahim
PESHAWAR/KARACHI, Dec 21 2012 (IPS)

The murder of nine health workers vaccinating children against polio in Pakistan’s northwest cities of Peshawar and Charsadda in the Khyber Pakhtunkhwa (KP) province, and its southern port city Karachi, have elicited shock and outrage.

Four female health workers were killed in Karachi, shot dead by masked men on motorbikes. The other five victims, including a 17-year-old volunteer, were slain in Peshawar and Charsadda.

These killings were preceded by another death in Karachi’s Sohrab Goth area on the first day of a planned three-day immunisation campaign across the city, which has now been suspended in the provinces of Sindh, Balochistan and parts of KP, located on the Afghanistan-Pakistan border.

For activists and health workers familiar with the political terrain here, this attack – heinous as it is – is just the latest incident in a long campaign spearheaded by the Taliban that will likely continue long after the media hype has died down.

Back in 2005, Maulana Fazlullah, leader of Tehreek-e-Nafaz-e-Shariat-e-Mohammadi (TNSM), a fundamentalist militant group intent on imposing Sharia law throughout the country, began using a local radio station to spread an anti-vaccine message in the Swat district of the KP.

“The campaign began long before militants set foot in Swat – Fazlullah would deliver sermons from mosques, warning people to stay away from the vaccination because it was ‘against Islam’,” Dr. Rasool Khan, with the Expanded Programme of Immunisation (EPI) at the Aga Khan University, told IPS.

As militants began to gain a stronghold in the Federally Administered Tribal Areas (FATA), Fazlullah became commander of the Swat chapter of the outlawed Tehreek-e-Taliban Pakistan and his opposition to the vaccine became an official Taliban slogan.

“Everywhere in Khyber Pakhtunkhwa and the adjacent FATA, the Taliban came out to oppose vaccination,” Rasool Khan said. The militants argued that the oral polio vaccination (OPV) was a ploy used by the U.S. and its Western allies in the ‘war against terror’ to render Muslims infertile and stem population growth.

This argument found favour with the local population, who had become sceptical of the campaign after observing United Nations officials and aid workers travelling around the region in limousines while carrying out immunisation drives.

By 2011 polio was endemic in only three countries worldwide: Pakistan, Afghanistan and Nigeria. After coming very close to eradication, with only 28 cases nationwide in 2005, Pakistan saw a rapid increase to 117 cases in 2008 and 144 in 2010. By 2011, the country had registered 198 cases of polio.

Since 2007, immunisation drives in the KP and FATA have recorded about 50,000 incidents of families refusing the OPV, according to the Health Department.

For years, vaccinators have been terrified for their lives, while others have avoided joining the campaign for fear of drawing the ire of militants.

Tahseenullah Khan, national coordinator of the National Research and Development Foundation (NRDF), which has supported the UNICEF-sponsored mobilisation campaign in KP and FATA since 2009, says his organisation hired the services of religious scholars and began to make progress in getting through to the local population.

But the scandal involving Shakil Afridi – a CIA agent posing as a doctor who set up a fake immunisation centre in the northern town of Abbottabad as a front to gain information on Osama bin Laden last year – worked greatly in the Taliban’s favour.

“Now the majority of people believe that what the Taliban were saying about the ulterior motives of the U.S. to send spies to militant strongholds was true,” Tahseenullah Khan told IPS.

But health workers refuse to be deterred. Through the grief comes a determination to re-double eradication efforts. Dr. Imtiaz Ali Shah, the focal person for polio immunisation in KP, told IPS that health workers are devising a new strategy to re-launch the campaign through elected representatives.

“We want to have a full-scale campaign to wipe out the ailment before it assumes the shape of a full-blown epidemic,” he said.

This determination is not limited to the tribal areas, which have long borne the brunt of fundamentalism and militarism, but is now widespread down in Pakistan’s urban centres as well.

Shahnaz Wazir Ali, adviser on polio to Pakistan’s Prime Minister Raja Pervez Asharf, who flew in from Islamabad to visit the injured and condole with the families of the four deceased health workers here, told IPS, “The Sindh government will have to do some serious stock-taking and revisit its present campaign – we need to reach every child.”

But experts in Karachi are not certain who was behind the well-coordinated killings. The Taliban have denied any involvement in the incident.

“I visit Landhi’s Gulshan-e-Buneer area every month and know the place like the back of my hand,” said 35-year-old Nasim Munir, head of the anti-polio campaign in the area where two women were killed, told IPS. She refuses to believe that the two health workers, Fehmida and her neice Madiha, were shot dead because of opposition to the OPV.

“If there was any ill-feeling, they (the health workers) would have been turned out of people’s homes or refused entry – not killed,” she stressed.

“This is a bigger plot and needs to be probed further,” she added.

“Till the investigations are complete, we can only speculate. The timing is significant in Karachi, where there is already much uncertainty and unrest,” said Wazir Ali.

President of the Sindh chapter of the Pakistan Medical Association, Dr. Samrina Hashmi, also remains uncertain about the Taliban’s hand in this, but speculated that the attacks were an attempt to “cause anarchy, and to try and disrupt the upcoming elections”, scheduled for March 2013.

“There is little doubt that this was a concerted plan to counter and block anything that was high priority for the government,” Wazir Ali added. She believes shooting women health workers sends the message that there are elements “capable of doing anything”.

“Who (else) would want to kill people who are working for the health of children?” Dr. Altaf Bosan, working as technical focal person for the Prime Minister’s Anti-Polio Cell, asked.

But he stressed, “We will not let anyone sabotage this programme, it was going very successfully.”

Indeed, with only 56 cases recorded in 2012, Pakistan has made good progress this year, contributing to the global decline in fatal and harmful cases of polio from 350,000 in 1998 to less than 1,000 last year.

But while the polio virus lives in even one child, the world remains at risk, experts say. The discontinuation of the campaign in the Sindh comes as a huge blow to health experts and others involved in the immunisation drive.

Dr. Mazhar Ali Khamisani, heading the Sindh Expanded Programme on Immunisation, told IPS, “It’s a major setback for our campaign. We have suspended the programme and have asked the government to conduct (a proper investigation) and catch the culprits before our volunteers venture into the field again.”

According to a government public health expert who has worked with the polio campaign since it began in 1994, speaking to IPS on condition of anonymity, “Today they stopped the campaign in Karachi, tomorrow they (could) stop it throughout Pakistan. Do we want a nation of handicapped people?”

While it is impossible for the government to provide security to each and every health worker in the field, Hashmi believes intelligence agencies need to be vigilant enough to outwit and preempt militants’ plans.

Meanwhile, the tragedy appears to have had one significant political repercussion: it has chilled the cosy relationship the Taliban once enjoyed with several religious groups across the country. Soon after the killings, Tahir Ashrafi, heading the Pakistan Ulema Council, said 24,000 mosques associated with his organisation would condemn the tragedy during the Friday prayers.

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.

After four years, tens of thousands of children in Pakistan’s Federally Administered Tribal Areas (FATA) are receiving the polio vaccination. Credit: Ashfaq Yusufzai/IPS

By Ashfaq Yusufzai
PESHAWAR, Pakistan, Sep 26 2012 (IPS)

Over thirty thousand children in the remote Tirah area of the Khyber Agency, part of the Federally Administered Tribal Areas (FATA) in Northern Pakistan, have waited four years for protection from polio, a viral disease that is sometimes referred to as ‘infantile paralysis’ due to its crippling effects on children.

A massive government and civil society effort through the month of September finally began to reverse the trend that had kept the children of Tirah, along with hundreds of thousands in the greater FATA area, under the shadow of polio.

Up until this year, children in all seven FATA agencies have been the worst victims of the Taliban’s ban on the oral polio vaccination (OPV), which the organisation claims was a ploy by the United States to render the recipients impotent and infertile, thus strangling the growth of the Muslim population.

On Jun. 20 the outlawed Tehreek Taliban Pakistan (TTP) banned vaccinations in North Waziristan, putting 161,000 at risk of contracting the preventable childhood disease.

A week later, the TTP in the adjacent South Waziristan province imposed a ban on numerous vaccinations that rendered 157,000 children vulnerable to eight preventable childhood ailments – polio, measles, diphtheria, hepatitis, meningitis, pertussis, influenza and pneumonia.

“Anyone found involved in vaccination-related activities was dealt with sternly,” TTP Spokesman Ihsanullah Ihsan said a statement, adding that the responsibility rested with those who advocated for any kind of vaccination.

Not even professional health workers were spared if they were found to be in violation of the ban.

“Due to the Taliban’s barbarism, such as beheading soldiers and local residents on charge of spying, stoning alleged ‘sinners’ (such as adulterers) to death and targeted assassinations, the Taliban have spread their message about the vaccinations loud and clear,” explained FATA Director of Health, Dr Fawad Khan.

Khan said that more than 6000 FATA health workers had been directed to stay away from vaccine-related work.

Earlier this month officials mounted an offensive against the ban. The government enlisted a local NGO, the National Research and Development Foundation, and religious scholars to hold talks with the outlawed jihadist outfit Ansar ul Islam (AI) to negotiate the terms of a vaccination programme.

The NGO began facilitating the vaccination on Sept. 4, an upbeat Dr. Aftab Akbar Durrani, social sector secretary of the FATA, told IPS.

He added that AI’s cooperation had enabled 95 percent of the children in the Tirah area to receive the vaccination.

“It is a major breakthrough, as many (previous) efforts to vaccinate children in the Taliban-controlled areas had failed,” officials told the English-language Dawn newspaper, crediting the organisation with protecting 32,641 children from polio.

Officials added that 11,626 children also received the vaccine against measles, while another 3,889 newborns and month-old infants were vaccinated against five other ailments between Sept. 4 and 6.

“Ansar ul Islam and religious leaders attached to the group understand that the poliovirus can cause lifelong disability so they are ready to support the initiative,” according to officials. Only four families refused to vaccinate their children, but efforts are currently underway to convince them otherwise.

“Ansar ul Islam played a vital role in countering community refusals,” officials told IPS

Fifty percent of children In Bara, a town in Khyber Agency, had not received the oral polio vaccine (OPV) since October 2009, owing to an ongoing operation against militants in the area.

Officials developed a new strategy to reach the inaccessible children in FATA, which included working in “collaboration with scouts (who) carried out door-to-door visit with the help of local vaccinators”.

Durrani told Dawn that aggressive efforts were underway to ensure immunisation of all 900,000 target children in FATA.

“We are administering OPV to the displaced children of Waziristan in the adjacent districts of Bannu, Tank and Dera Ismail Khan where they live in rented houses or with their relatives,” he said.

He said that more than 25,000 displaced children from Orakzai Agency had been vaccinated in the nearby Hangu district, while 50,000 children In Jalozai had also received the OPV.

“Displacement has been proving a blessing in disguise for the displaced children, who are getting protection against eight vaccine-preventable ailments through immunisation,” Durrani said.

A three-part campaign throughout September saw the immunisation of 600,000 children in FATA while 300,000 were still inaccessible.

(END)

Governor Babatunde Fashola of Lagos immunising a child. Courtesy: Toluwa Olusegun

By Toluwa Olusegun
LAGOS, Nigeria, Jun 19 2012 (IPS)

Twelve-year-old Sunday Oderinde sits by the side of the road with both legs folded under him and watches his friends play a game of soccer on the streets of Iwaya, a suburb in Lagos, Nigeria. It is a game that he would love to join in but cannot.Oderinde contracted polio as a child. Though 90 percent of polio infections cause no symptoms at all, Oderinde’s limbs were paralysed. Now he can only walk with the help of crutches, which he keeps by his side as he watches as the game plays out on a makeshift football pitch.

“I watch them playing, but I cannot play because of my condition. I saw some people like me with roller skates on television playing ball with their hands. I would like to play like them if I have the chance,” Oderinde tells IPS.

When Oderinde was a baby his mother, Aminat Jimoh, did take him to the local clinic for his immunisations and vaccinations. Among those he received were doses of the oral polio vaccine (OPV), which is administered to children under the age of five.

According to the Global Polio Eradication Initiative, while OPV is highly effective against all three types of wild poliovirus (WPV), one dose of the vaccine only produces immunity in 50 percent of recipients. “Three doses produce immunity in more than 95 percent of recipients. Immunity is long-lasting and probably life-long.” In Nigeria, five doses of the vaccine are administered.

And like many mothers here in this West African nation, Jimoh, an informal trader, did not continue taking her child to the clinic to receive the full schedule of OPV dosages.

She tells IPS that at the time she was so busy trying to fend for her family that she did not feel it was important.

“I have to take care of my family and my trade occupied my time. I did not remember to take him for all the rounds of immunisation. That was my mistake.

“We noticed when he turned two years, Sunday could still not walk … and by the time we finally took him to hospital, it was too late,” she says.

Attitudes like this are among the reasons that Nigeria remains one of three countries, including Pakistan and Afghanistan, still battling the WPV.

Tommi Laulajainen, chief polio communications officer for the United Nations Children’s Fund (UNICEF) in Nigeria, tells IPS that in key infected states like Borno, Kano, Sokoto and Yobe, which are all in the country’s north, one in three children have received less than four of the scheduled five doses of OPV.

He adds that the number of times health officials visit households during national immunisation days to vaccinate children has dropped, which has led to a reduction in the number of children who receive OPV.

“Children are missed during immunisation campaigns due to a mixture of operational and social factors. Low routine immunisation coverage is a major contributor to Nigeria’s situation,” he explains.

Laulajainen says that as of May 2012 Nigeria recorded 32 cases of WPV in 10 states. This was an increase from the 16 cases that occurred in six states for the same period in 2011.

“Nigeria remains the only polio endemic country in Africa. This year the country has contributed 90 percent to the polio burden in Africa and more than 50 percent of this year’s cases worldwide are from Nigeria,” he says.

In addition, polio-free states like Kaduna, in north-central Nigeria, and the neighbouring nation of Niger have been re-infected in 2012. The Global Polio Eradication Initiative says that Niger will continue to be at risk for re-infection until Nigeria interrupts transmission of WPV.

According to the World Health Organization, the continued failure of Nigeria to end polio will cause the virus to spread to neighbouring countries, which had been previously declared polio-free.

“As long as a single child remains infected, children in all countries are at risk of contracting polio. The success of polio eradication in Africa rests on Nigeria interrupting the virus,” the WHO says.

However, analysts blame the increase in polio cases on a number of other problems, including corruption.

Dr. Olarenwaju Ekunjimi, president of the Association of Resident Doctors at the Lagos University Teaching Hospital, says corruption is hindering Nigeria’s ability to interrupt transmission of the virus.

“Corruption in the system will not allow a polio-free Nigeria by 2015. I will be surprised if it is achieved with the level of corruption in the country.

“Everybody wants to make money out of the system so long as donors continue to pump money into the programme. If the government achieves total eradication of polio, the funds will stop and people benefiting from it will lose out,” says Ekunjimi.

President Goodluck Jonathan inaugurated a Presidential Task Force on Polio Eradication on Mar. 1 and gave the committee 24 months to eradicate the virus in Nigeria. He announced increased funding for the campaign from 22 million dollars last year to 30 million dollars for 2012.

UNICEF contributed 15.14 million dollars to polio eradication in 2011. The Nigerian federal and state governments have also announced measures to contain the virus and ensure a polio-free nation by the year 2015.

However, Ekunjimi suggests that instead of government increasing funding for the eradication of polio, it should establish primary health centres across the country so that babies receive immunisation against all childhood killer diseases while still small.

“Catch them at infancy at the centres and then continue to immunise those outside through the routine monthly or quarterly immunisation exercises. That way polio will be totally eradicated in Nigeria,” he says.

Professor Oyewole Tomori, a virologist and former vice chancellor of the University of Ibadan, in south western Nigeria, blames leaders at all levels of government for the continued presence of polio in the country. He says that polio can be eradicated within three years if the country’s leaders do the right thing.

Tomori told participants at the 43rd Annual General Meeting and Scientific Conference of the Pediatric Association of Nigeria in mid-February that lack of proper planning and implementation were the bane of government policies in Nigeria.

Radical religious leaders are also to blame for the continued presence of the virus. In 2003, in the northern state of Kano, a Muslim leader opposed a polio immunisation programme, as he claimed that it was a Western plot to make people infertile. Although he later dropped his opposition to it, the damage had been done.

According to reports from the region, most Muslim caregivers still refuse to take their children for the OPV. Meanwhile, UNICEF has deployed a team of volunteer community mobilisers to address the issue there.

Pakistan’s efforts to contain polio in areas bordering Afghanistan may have received a setback following the conviction of a doctor who allegedly ran a fake vaccine programme to locate Al-Qaeda chief Osama bin Laden.

Dr. Shakil Afridi, who was sentenced to 30 years in prison on May 23 on charges of treason, is said to have helped the Central Intelligence Agency (CIA) of the United States track down bin Laden by collecting DNA samples from selected residents in the cantonment town of Abbottabad.

Bin Laden was killed in a U.S. raid on his secret residence in Abbottabad in May 2011. Afridi was arrested by Pakistani authorities three weeks later, leading to friction between Islamabad and Washington.

Médecins Sans Frontières, the international medical aid charity, had then warned that the CIA’s alleged use of a vaccination programme as cover to spy on bin Laden threatened immunisation work around the world.

Afridi’s role appears to have exacerbated suspicions among people in the Federally Administered Tribal Areas (FATA) that polio vaccinations are part of a U.S. conspiracy to render their children infertile.

“The problem of refusing vaccination is not new but Afridi’s fake vaccination campaign has proved to be a setback to our efforts to popularise immunisation,” Dr. Rekhanullah Khan, a polio officer in the FATA, told IPS.

This year, Pakistan has already recorded 22 cases of polio with 10 of them from the FATA, a territory consisting of seven tribal agencies.

“In the FATA, authorities are facing difficulties reaching children of immunisable age,” said Dr. Javid Khan of the World Health Organisation (WHO).

“In the Khyber Agency of the FATA, which recorded its eighth case last week, oral polio vaccines have not been administered since October 2009, leaving some 150,000 children vulnerable,” Javid Khan told IPS. “This is a programme by the U.S. to cut the population of the Muslims and weaken them to a point that they become incapacitated to defend Islam,” Qari Mohammad Akram, a resident of FATA’s Bajaur agency, told IPS over telephone.

“People here don’t want any treatment for a disease that has not affected them. We need to follow teachings of Islam and heed the Prophet,” he argued.

Refusal to cooperate with health authorities is also because FATA residents are demanding a better deal from the central government.

“Last week, parents refused to allow vaccination in South Waziristan agency, saying they would prefer to have electricity, paved roads and clean drinking water first,” Dr. Muhammad Khalid of the expanded programme on immunisation (EPI) in the FATA, told IPS.

The ‘Dawn’ English language daily, published from Karachi, quoted Dr. Elia Curry, leader of the WHO’s polio eradication section in Pakistan, as saying on Jun. 9 that the virus will continue to circulate as long as anti-polio drives miss significant numbers of children.

Curry told Dawn that environmental surveillance, covering sewer systems, had proved persistent circulation of wild poliovirus in cities like Lahore and Rawalpindi with children in the provinces of Punjab and Khyber Pakhtunkhwa particularly vulnerable.

According to WHO’s website, the Khyber Agency is the only area in Asia having both the wild poliovirus-1 and wild poliovirus-3 types and this poses a threat to efforts at polio eradication in the country as well as globally.

WHO officials said there was added risk of the virus spreading from the FATA to other parts of the country because of the ongoing large-scale population migration to other parts of the country.

An immunisation drive begun in selected areas of Pakistan on Jun. 4 is expected to reach at least 17 million children, but would still miss children in the FATA because of military operations against the Taliban in several areas, particularly the Khyber Agency.

Some parents are convinced that unsettled conditions in the FATA are mainly responsible for polio continuing to threaten their children.

“Both the army and Taliban are responsible for making my daughter crippled,” says Allah Noor, whose 21-month-old daughter, Salma, was diagnosed with polio on Jun. 1.

“Obviously vaccinations cannot be carried out when fighting is in progress and the health facilities are closed,” Noor, a resident of Usai Khula village of the Khyber Agency, said. “I want to tell all parents to cooperate and save their children from vaccine-preventable ailments,” he told IPS.

In early April, the WHO had requested Khyber Pakhtunkhwa’s provincial government to carry out mass immunisations in the Jalozai refugee camp, home to 40,000 children uprooted by military operations in the FATA.

On WHO’s request, Dost Muhammad Khan, chief justice of the Peshawar High Court, ordered the setting up of transit points to vaccinate children fleeing military operations in the FATA’s Khyber Agency and reaching the Jalozai camp.

“We established 48 vaccination points where children coming in from the Khyber Agency are being vaccinated,” Dr. Jan Baz Afridi, who heads the EPI in Khyber Pakhtunkhwa, said.

In 2011, Pakistan emerged as the worst polio-infected country in the world with 198 cases and this year will be no different if urgent measures for mass immunisation are not taken, according to WHO officials.

(END)