How African countries battled and contained spread of the highly infectious virus
Poliomyelitis commonly shortened to polio, is an infectious disease caused by the poliovirus. In about 0.5 percent of cases, it moves from the gut to affect the central nervous system, causing muscle weakness resulting in a flaccid paralysis. This can occur over a few hours to a few days. The disease is transmitted from person-to-person mainly by the fecal-oral route and by aerosol droplets.
While there is no cure for polio, the disease can be prevented through administration of the effective novel oral polio vaccines (nOPV2). Mass vaccinations and supplementary vaccinations are the best weapons for combating the circulation of poliovirus. Every child under 5 years should be immunized with oral polio vaccine regardless of previous immunization status.
The recent polio outbreaks are undisputedly interlinked to the COVID-19 pandemic and lockdowns, which resulted in suspension of immunization activities and disruptions to poliovirus surveillance in 2020. Vaccination campaigns have also been hampered by the international spread of poliovirus via travelers. The World Health Organization (WHO) declared the international spread of wild poliovirus a public health emergency of international concern in response to ongoing importations of poliovirus into polio-free countries.
Medical and scientific understanding, lifestyles and living conditions, socio-political forces and other determinants play a key role in how nations will control and manage the polio outbreaks in Africa. Let us explore public health responses that have been put in place by various governments and agencies to eradicate the crippling disease:
Existing global polio eradication strategy
In 2021, the Global Polio Eradication Initiative (GPEI) launched the Polio Eradication Strategy 2022-2026: Delivering on a promise to overcome the remaining challenges to ending polio including setbacks caused by COVID-19. The Global Polio Eradication Initiative is a public-private partnership led by national governments with six international partners focused on eradicating polio worldwide. The six partners include the World Health Organization (WHO), Rotary International, the US Centers for Disease Control and Prevention (CDC), the United Nations Children’s Fund (UNICEF), Bill & Melinda Gates Foundation and the vaccine alliance Gavi.
The 2022-2026 Strategy underscores the urgency of getting eradication efforts back on track and offers a comprehensive set of actions that will position the GPEI to achieve a polio-free world. The strategy encompasses further integration of polio activities with essential health services like routine immunization and building closer partnerships with high-risk communities to co-design immunization events and better meet their health needs. Applying a gender equality lens to the implementation of program activities along with recognizing the importance of female workers to build community trust and improve vaccine acceptance also plays a central role in furthering the immunization agenda.
The scheme also aims to implement innovative new tools such as digital payments to frontline health workers to further improve the impact and efficiency of polio campaigns. GPEI members are currently working to strengthen advocacy to urge greater accountability and ownership of the program at all levels including enhanced performance measurement and engagement with new partners such as the new Eastern Mediterranean Regional Subcommittee on Polio Eradication and Outbreaks. In addition to eradicating wild polio, GPEI will strengthen efforts to stop outbreaks of circulating vaccine-derived poliovirus (cVDPV) that continue to spread in under-immunized communities across Africa and Asia.
Malawi’s successful polio vaccination drive
The initial outbreak of polio in Africa in more than five years was declared by Malawian health authorities after a three-year-old Malawian girl experienced onset of paralysis on 19th November 2021. Sequencing of the virus was conducted in February by the National Institute for Communicable Diseases in South Africa and the United States Centers for Disease Control and Prevention (US CDC) confirmed this case as poliovirus (WPV type 1). Laboratory analysis linked the strain detected in Malawi to the one circulating in Sindh Province in Pakistan since October 2019 as polio remains endemic in Afghanistan and Pakistan.
Subsequently, Malawi promptly launched public awareness campaigns about wild polio to alert the public of the wild poliovirus outbreak as well as provide information about poliovirus and the vaccine for the virus. The Malawian government recently launched the second round of mass polio vaccinations after the country successfully completed the first phase of vaccination campaigns for children under 5 years against wild poliovirus in its four-round vaccination drive. The Ministry of Health administered over 6.9 million doses of oral polio vaccine procured by the United Nations Children’s Fund (UNICEF) targeting 2.9 million children under five in the first vaccination drive. A Poliovirus Outbreak Response Situation Report released by the government states that 2.97 million children aged between 0 – and 59 months have been vaccinated in the campaign representing 102 percent administrative coverage.
UNICEF partnered with the WHO and the Global Polio Eradication Initiative including the Bill and Melinda Gates Foundation, Rotary International and Global Alliance for Vaccines and Immunization in supporting the Ministry of Health to vaccinate children. Malawi also instituted risk assessment and disease surveillance measures to contain any potential spread of polio and there have not been any additional cases of polio reported so far ever since. WHO collaborated with health authorities to reinforce public health response measures including preparations for the vaccination campaigns. In preparation for the vaccination drives, trained surge teams of national officers have been deployed to facilitate the campaign and ensure that all eligible children are vaccinated.
Moreover, the country has set up environmental surveillance for polioviruses in 11 sites across four cities in Lilongwe District that encompasses the capital Lilongwe where the initial and so far, only case was detected. Other sites are in Blantyre, Mzuzu and Zomba cities as well as in health facilities and communities where health teams are collecting samples from the environment and sending them for analysis to laboratories.
The Global Polio Eradication Strategy 2022-2026 underscores the urgency
of getting eradication efforts back
on trackand offers a comprehensive set of actions that will position the GPEI to achieve a polio-free world.
Polio disease management in Mozambique
Mozambiquan health authorities declared a polio outbreak on 18th May 2022 after confirming that a child in the country’s northeastern Tete province had been paralyzed by the disease. Prior to the confirmation, Mozambique partnered with the United States to vaccinate 4.8 million children under five years old in the first round of the polio immunization round in an effort to contain the spread of the wild poliovirus. The immunization drive which has largely exceeded the target of 4.2 million children was in response to cases of poliomyelitis identified in Nampula, Cabo Delgado Provinces, and neighboring Malawi. The Ministry of Health (MISAU) implemented the national campaign with support from the US Centers for Disease Control and Prevention and the US Agency for International Development (USAID) in a step towards eradicating polio worldwide. Mozambique also received funding and technical assistance from local and international partners to support the vaccination campaign including the Mozambique’s Field Epidemiology Training Program, MOMENTUM Routine Immunization Transformation and Equity (M-RITE) among others. MISAU and Global Polio Eradication Initiative partners further partnered with the United States in the second round of the polio vaccine campaign to curb the ongoing circulating polio outbreak.
Infection prevention control activities in Uganda and Egypt
Uganda’s Ministry of Health (MOH)coordinated with the Uganda National Expanded Programme on Immunisation to launch a three-day mass polio vaccination campaign targeting 8.8 million children under five years. The country had been certified polio-free in October 2006, but the health ministry declared an outbreak of polio in August 2021 following confirmation of laboratory tests from samples in Kampala. Subsequently, the ministry partnered with USAID through the Regional Health Integration to Enhance Services-North, Lango (RHITES-N, Lango) project to develop strategies to support the mass polio vaccination campaign.
In Egypt, the government launched a national campaign to vaccinate children against polio for free across the country from 27th to 30th March. The vaccination campaign against polio was implemented in all governorates of the republic for every child under 5 years residing in Egypt regardless of their citizenship. The campaign’s work was carried out by 45,000 medical teams with a total of 90,000 individuals trained at the highest level. The Ministry of Health also collaborated with the Ministry of Education, Ministry of Social Solidarity and Al-Azhar campaign to facilitate polio vaccination in kindergartens and nurseries.
Somalia leveraging the power of partnerships
Somalia, members of the Global Polio Eradication Initiative and other key partners have endorsed the Somalia Polio Eradication Action Plan 2022 to reaffirm their commitment to end the ongoing circulating poliovirus type 2 (cVDPV2) outbreak and keep the country free from wild poliovirus. The Somalia Polio Eradication Action Plan complements one of the goals outlined in the GPEI Polio Eradication Strategy 2022–2026 to stop cVDPV transmission and prevent outbreaks in non-endemic countries. The Action Plan outlines a four-point strategy to contain the spread of the current poliovirus type 2 outbreak which was detected for the first time in the environment in November 2017 and in a child on 11th May 2018. The polio eradication plan aims to direct partners’ efforts and resources towards boosting population immunity through combined efforts to reach high-risk populations like inaccessible and nomadic communities as well as internally displaced persons. The detailed plan targets high-risk populations where children may have missed out on vaccinations to strengthen their immunity, provide routine childhood immunization and strengthen community engagement. The emergency plan will also advocate for stronger cross-border coordination among the polio eradication programmes in Somalia, Kenya, Ethiopia and Djibouti to avoid virus spill over into international borders.
Somalia’s polio eradication programme has made progress including stopping outbreaks of wild poliovirus as well as the recent circulating poliovirus type 3 in 2021.The programme has also established a vast network of polio workforce and assets including human and operational resources which will help contain the current outbreak as well as achieve broader health system goals.
Coordinated efforts key in keeping Polio at bay
The reemergence of Polio in the Africa threatened to roll back years of hard work that medical systems in the continent had put in place to keep the virus at bay. Concerted efforts by health ministries in collaboration with development partners have however been able to contain the spread of the virus. These efforts also prove once again that properly planned and well executed vaccination campaigns are effective in the fight against polio. The reemergence of the virus also underscores the importance of surveillance in the early detection and containment of possible outbreaks. Africa will only maintain its Polio free status if countries remain alert as complacency will only create room for the virus to sneak in from regions such as Pakistan and Afghanistan where it is endemic.
This feature appeared in the June 2022 issue of Healthcare Middle East & Africa. You can read this and the entire magazine HERE
