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World Polio Day 2022: Is Polio Becoming a Wicked Problem?

While polio exists anywhere, it’s a threat everywhere” — Ian Riseley, President, The Rotary Foundation
 
Nigeria was declared wild poliovirus free on the 25th August 2020. The news was met with a lot of celebration. The long-fought battle towards a wild polio free status had been won in Africa. Nigeria was the final country in which this was achieved on the continent. As this news came in the midst of the pandemic, it provided some much-needed good news against the background of uncertainty, as COVID-19 infections and deaths continued to escalate globally. The only countries at the time that had not yet eliminated wild poliovirus were Pakistan and Afghanistan where the wild poliovirus was still circulating. However, despite the wild poliovirus-free status in Nigeria, children still remain at risk from circulating vaccine-derived poliovirus (cVDPV), due to low immunisation rates in some communities, exacerbated by COVID-19 which disrupted routing immunisation programmes.

Following the outbreak of wild poliovirus, the government started a mass vaccination campaigns. Photo credit: UNICEF Malawi

The wicked problem of polio rears its head
The recent re-emergence of wild polio in Malawi and Mozambique, detection in waste water in London and New York and persistence of circulating vaccine-derived polio viruses in a few countries has been a wakeup call for the global community, as the challenge of eradicating polio worldwide becomes more evident. In February 2022, Malawi reported an outbreak of wild poliovirus type 1, as a 3-year-old child in the capital city, Lilongwe was left paralysed. The resurgence of wild poliovirus in Malawi came 30 years after the last case was reported in 1992. The government went into rapid response mode, activating a series of mass vaccination campaigns supported by World Health Organisation (WHO) and other partners.

The new cases of wild poliovirus show how the fragile progress in the eradication effort can be hampered and provides further evidence that eradication efforts have to be sustained, until we achieve our target worldwide. This calls for continued global solidarity and collaboration.

Global partners collectively committed $2.6 billion to the GPEI’s 2022–2026 Polio Eradication strategy. Photo credit: World Health Summit, 2022

Investing in a polio-free future: global partnerships and collaboration
The eradication effort was made possible by the partnership, collaboration and collective efforts of Global Polio Eradication (GPEI) partners including the Global Alliance for Vaccines and Immunisation (GAVI), the Bill & Melinda Gates Foundation, Rotary International, US Centres for Disease Control (CDC), as well as the numerous health professionals, civil society, community workers and religious leaders in Nigeria. These partners support work done by the responsible agencies at the national and state levels in Nigeria, working on these objectives every day.
 
The just concluded World Health Summit in Berlin, between the 16th — 18th October provided an opportunity for a recommitment to the polio eradication effort. As Svenja Schulze, Federal Minister for Economic Cooperation and Development for Germany reminded the delegates, “no place is safe until polio has been eradicated everywhere”. The recommitment efforts kicked off when Bill Gates, during the prestigious Virchow Prize for Global Health award ceremony for Ambassador John Nkengasong made the announcement that the Bill & Melinda Gates Foundation would commit $1.2 billion to support the GPEI’s 2022–2026 Polio Eradication Strategy. During the pledging event co-hosted by the GPEI and Germany’s Federal Ministry for Economic Cooperation and Development (BMZ), global leaders pledged $2.6 billion to fund the eradication efforts. In addition, Dr. Chris Elias, President, Global Development at the Bill & Melinda announced that the Foundation would be extending their two to one funding match with Rotary International for a further three years.
 
There is a window of opportunity to end polio and ensuring there is sustained funding for the polio eradication effort is a political choice. The commitments made by global partners reaffirm the global commitment to a polio-free future.
 
A healthier future for mothers and babies
During the pledging event at the World Health Summit, the audience heard from Minda Dentler, a Polio survivor and advocate. In a very moving session, she shared her lived experience of contracting polio as baby in India, as her birth mother did not have access to the polio vaccine. She became paralysed and is now in a wheelchair. However despite this initial challenge, she has since graduated from university, earned an MBA and is now the proud mother of a daughter.

Minda Dentler shares her story during the World Health Summit, 18th October 2022. Photo credit: Nigeria Health Watch

This year’s World Health Organization’s World Polio Day 2022 and Beyond: A healthier future for mothers and children closely resonates with Minda’s experience, as it puts women and children front and centre of the polio eradication effort. As the Director General of the World Health Organization, Dr Tedros Ghebreyesus iterated during the polio pledging session at the World Health Summit, “Gender equality is critical to achieving eradication because in many of the most affected communities, only women are allowed access to homes and children, other than their own”.

 Minda’s experience and that of her birth mother are very similar to that of many women and children in Nigeria who do not have easy access to the life-saving polio vaccines, despite the efforts of government and partners. This emphasises the need for sustained funding to reach women and children, especially zero-dose children in remote areas and internally-displaced camps in Nigeria. These populations are especially vulnerable, as the children have been left out of routine immunisation programmes and mothers do not have access to basic maternal health services. The GAVI Zero-Dose Immunization Programme (ZIP) in collaboration with the International Rescue Committee and World Vision aims to reach children in displaced and hard to reach communities or immunisation “blind-spots”.
 
Redi Tlhabi, BBC journalist and moderator at the pledging event stated that “gender is a powerful determinant of health outcomes”, this is especially true because in communities and countries where there was a high level of gender equality, routine immunisation rates for children tend to be higher. This highlights why we have to double down in our efforts to empower women and girls, ensuring that girls have the opportunity to complete their secondary school education. The GPEI’s gender equality strategy seeks to “identify and address gender-related barriers”. Addressing the polio eradication effort needs to have a focused gender lens, especially given that a large number of health workers, especially community health workers are women. Women remain at the forefront of the polio eradication effort and gender roles and norms need to be understood, as many of the community health workers lead the disease surveillance activities.

World Polio Day 2022 and Beyond: A healthier future for mothers and children. Photo credit: poco_bw/Adobe Stock

Polio eradication is a good investment
The continued efforts to eradicate polio comes at a significant opportunity cost. According to Dr Chris Elias, eradication is a good investment because it will “by economic projections save the world about $33 billion in this century” when compared to the cost of controlling the disease. The eradication effort also directs the focus and resources dedicated to health programmes at the elimination efforts. In Nigeria, our basic health systems, especially primary health care, remain weak and severely underfunded. Strengthening the primary health care system, especially in the most affected communities will ensure a stronger response to public health threats in addition to meeting the basic health needs of communities, especially the most vulnerable which includes women and children.
 
World Polio Day 2022, reminds us that we must “leave no one behind” and it is an opportunity to highlight the global efforts being made to eradicate the wild polio and a reminder that leveraging on the power of collaboration, a polio-free world remains within our reach.

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