A chain that’s dragging polio into the past

Wednesday, October 24th, 2018 in Blog
(English only)

By: Raseema Alam, Board Director

The good news is that we’re winning in the fight against polio. Globally, the number of new cases has plummeted from 294 in 2014, to 22 in 2018. Some parts of the world are seeing even greater success: Nigeria, for example, has been declared polio-free for two years.

The not-so-good news is that we haven’t won yet. There are still active cases occurring, and until this highly infectious disease is completely eradicated, it will continue to spread.

So what is helping drag polio into the past tense, once and for all? A chain. This chain consists of a series of steps, initiatives, and organizations who are pulling together to eradicate polio, and it’s working.

This chain has four links, and as with any chain, all links must stay strong – because a weakening or breaking of any of these can cause failure in the work to eradicate polio.

Link One: The money and political will in donor countries

The first link in the chain involves Canadians. The Government of Canada’s role in the eradication of polio comes in providing funding to buy and distribute vaccines in places where polio is still to be found. Additionally, Canadians are hard at work to build awareness across the country with grassroots groups like RESULTS Canada, to educate global citizens on pressing child health issues. RESULTS Canada is part of a larger international network which takes on a global advocacy role for a variety of health initiatives about preventable child deaths, in areas such as water and sanitation, HIV/AIDS, and immunizations. Through this model, they work both locally and internationally to support key development issues.

Without ongoing citizen advocacy of immunization spending, political attention may go elsewhere, along with the funding for immunization. Canadians can help by lending their financial and volunteer support, as well as communicating with government representatives, to advocate for continued funding to eradicate polio.

Link Two: Vaccine Delivery

One key element to eradicating polio is vaccines. UNICEF, working to improve the lives of children for over 70 years, works with pharmaceutical companies like Sanofi Pasteur and GlaxoSmithKline to purchase the polio vaccine. UNICEF, then works with local communities to deliver the vaccine directly to children in affected areas.

One of the reasons that polio eradication has had recent spectacular success has been in improvements in another type of chain – the “cold chain.” Many vaccines, including those for polio, must be kept at a cold temperature in order to retain their effectiveness – generally, between 0 degrees Celsius and 8 degrees. There used to be significant problems maintaining this cold chain right from the manufacturer to the place where the vaccine is administered to a child in a country such as Pakistan. UNICEF has been an invaluable help in two ways – using its expertise and purchasing power to procure vaccines, and then using its local contacts to match supply and demand to deliver the vaccines to individual communities. 

Improved distribution networks, so the vaccine is shipped from the manufacturer directly to local storage facilities, have been part of the answer. As have improved portable containers – resembling insulated lunch boxes – so that field workers can avoid breaking the cold chain, keeping the vaccines at the right temperature until administered. Having the vaccines manufactured in India and Indonesia builds cultural acceptance.

Link Three: Building local acceptance and support

It is clear that there has been a transformation in Pakistan. The watershed moment came in 2014, when the highest number of cases -totaling over 300 – were reported. Since 2015, the number of cases reported in Pakistan have steadily decreased.

A big hats-off salute to all of the local organizations that have helped polio vaccination teams gain access to even the smallest villages in remote valleys in Pakistan’s mountainous Khyber Pakhtunkhwa (KPK) Province, where the need for polio immunization is greatest and most difficult to meet.

Much of the credit goes to Pakistan’s leadership including that of Prime Minister Imran Khan, in making polio eradication a priority – including the ambitious yet achievable goal of eradicating polio in Pakistan, by the end of 2019. The government’s plan includes investment in the transportation networks and communication needed to make this happen. Another key success factor is that the Prime Minister has appointed a focal person for polio to deliver on the Action Plan for Polio Eradication. 

Another success is due to the on-the-ground work of UNICEF, which coordinates with local organizations and volunteers, often acting as the “honest-broker” to pull away barriers and roadblocks (some of them being actual roadblocks) to making national immunization a reality.

Technology has helped. When I was working as the manager of the polio eradication program on behalf of the Government of Canada, in Pakistan and Afghanistan in 2011, we began national immunization notification campaigns via SMS. These were the humble beginnings of a social media campaign. Now, with the advances in affordable mobile infrastructure, data, and smartphones, the options are wide open. For example, each month, citizens get notifications about national immunization via their mobile service carriers, who transmit messages to their customers. The polio eradication program now has access to Facebook groups and WhatsApp groups (in addition to the radio, and public information ads on TV).

Link Four: Reaching every child

These three links are feeding the ability of the fourth link – the local push to reach every child. This is the goal of all organizations from the local to the global organizations.

Perhaps surprisingly, one of the brightest lights of the polio immunization program has been the all-out push by citizens in Pakistan. This includes previous skeptics and insurgent groups in KPK. Many of these groups developed a strong suspicion of immunization efforts ever since reports surfaced that US intelligence had used immunization drives as cover for their quest to find and kill Osama bin Laden, and rumors that vaccines made adults sterile.

But more recently, community health workers have opened up new dialogues with insurgent groups. Through dialogue, insurgent groups controlling remote areas of the mountains have become enthusiastic supporters of immunization efforts. They want their children, and those in the communities they control, to be healthy. So, these groups deserve kudos for their about-face in not just allowing, but supporting and facilitating, immunization workers.

Another key role in the success of the fourth link in the chain has been played by the team of Lady Health Workers (LHWs). Given the conservative nature of many parts of KPK, only women would be able to enter the home of a mother with a young child to administer vaccine. So many LHWs, from the community and therefore trusted, make it their purpose to ensure that all young children get vaccinated – particularly important as polio vaccine must be given to a child before the age of five.

It is through all of these moving parts working together that have resulted in the 99% eradication rate. All the links in the chain are needed for polio to be dragged into the past, so it no longer threatens the world. It is true that we are almost there.

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