Nabeela, a polio frontline worker in Pakistan, vaccinates a child in Liaqatabad using the ‘no touch’ method. © UNICEF/Pakistan

Vaccinators in countries including Afghanistan, Angola, Burkina Faso and Pakistan took to the streets this month to fill urgent immunity gaps that have widened in the under-five population during a four month pause to polio campaigns due to COVID-19.

Campaigns resumed in alignment with strict COVID-19 prevention measures, including screening of vaccinators for symptoms of COVID-19, regular handwashing, provision of masks and a ‘no touch’ vaccination method to ensure that distance is maintained between the frontline worker and child. Only workers from local communities provided house-to-house vaccination to prevent introduction of SARS-CoV2 infection in non-infected areas.

Although necessary to protect both health workers and communities from COVID-19, the temporary pause in house-to-house campaigns, coupled with pandemic-related disruptions to routine immunization and other essential health services, has resulted in expanding transmission of poliovirus in communities worldwide. Modelling by the polio programme suggests a potentially devastating cost to eradication efforts if campaigns do not resume.

A child has their finger marked during the campaign in Angola. ©WHO/AFRO

In Afghanistan, 7858 vaccinators aimed to vaccinate 1 101 740 children in three provinces. Vaccinators were trained on COVID-19 infection control and prevention measures and were equipped to answer parents’ questions about the pandemic. Through the campaign, teams distributed 500 000 posters and 380 000 flyers featuring COVID-19 prevention messages.

In Angola, 1 287 717 children under five years of age were reached by over 4000 vaccinators observing COVID-19 infection prevention and control measures. All health workers were trained on infection risk, and 90 000 masks and 23 000 hand sanitizers were distributed by the Ministry of Health.

In Burkina Faso, 174 304 children under five years of age were vaccinated in two high-risk districts by 2000 frontline workers. Vaccinators and health care workers were trained on maintaining physical distancing while conducting the vaccination. 41 250 masks and 200 litres of hand sanitizer were made available through the COVID-19 committee in the country to protect frontline workers and families during the campaign.

In Pakistan, almost 800 000 children under the age of five were reached by vaccinators in districts where there is an outbreak of circulating vaccine-derived poliovirus. Staff were trained on preventive measures to be followed during vaccination, including keeping physical distance inside homes and ensuring safe handling of a child while vaccinating and finger marking them.

Farzana, a polio worker in Karachi’s Liaqatabad Town, Pakistan uses hand sanitizer during the campaign. ©UNICEF/Pakistan

“Our early stage analysis suggests that almost 80 million vaccination opportunities have been missed by children in our Region due to COVID-19, based on polio vaccination activities that had to be paused,” said Dr Hamid Jafari, Director for Polio Eradication in the Eastern Mediterranean Region. “That’s close to 60 million children who would have received important protection by vaccines against paralytic polio.”

Over the coming months, more countries plan to hold campaigns to close polio outbreaks and prevent further spread, when the local epidemiological situation permits.

“Our teams have been working across the Region to support the COVID-19 response since the beginning of the pandemic, as well as continuing with their work to eradicate polio,” said Dr Hamid Jafari. “We must now ensure that we work with communities to protect vulnerable children with vaccines, whilst ensuring strict safety and hygiene measures to prevent any further spread of COVID-19”.

In Afghanistan, 7858 vaccinators aimed to vaccinate 1 101 740 children in three provinces. ©WHO/Afghanistan

Dr Matshidiso Moeti, WHO Regional Director for Africa, commented, “We cannot wait for the COVID-19 pandemic to be contained to resume immunization activities. If we stop immunization for too long, including for polio, vaccine-preventable diseases will have a detrimental effect on children’s health across the region.”

“The campaigns run by the Polio Eradication Programme demonstrate that mass immunization can be safely conducted under the strict implementation of COVID-19 infection prevention and control guidelines.”

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The tricycles are hand-crank operated by the individual to navigate the difficult roads of Burkina Faso. A wider version is also available for adults riding with children and the chairs can be tailor-made in a variety of colours. ©Rotary
The tricycles are hand-crank operated by the individual to navigate the difficult roads of Burkina Faso. A wider version is also available for adults riding with children and the chairs can be tailor-made in a variety of colours. ©Rotary

Outside a sandy coloured building in a village in Burkina Faso, a young girl on crutches is making her way out onto the street. In front of her home is a new wheelchair – child-sized, brightly painted and specially adapted to the unpaved streets of her neighbourhood.

Countries around the world are united in their efforts to eradicate polio so that it will never again cause a child to be paralysed. This is important because there is no cure to this paralysing disease. For polio survivors in Burkina Faso, the opportunity to be independently mobile in their own communities can be life changing.

Independence after disability

For children living in poor communities whose limbs are paralyzed by polio, there is often very little support available to make them independently mobile. Giving a child a wheelchair puts previously inaccessible opportunities within reach so that children can reach their potential; such as going to school, playing outside with friends and learning new skills. In many cases the children are free to explore the world around them for the first time without a friend or family member to help.

Rotary International, along with partners such as Sahel, are providing support to the AMPO Association in Ouagadougou to provide services and facilities for children, teenagers, young mothers and people with disabilities often caused by polio.

Custom-made wheelchairs

The tricycles are hand-crank operated by the individual to navigate the difficult roads of Burkina Faso. A wider version is also available for adults riding with children and the chairs can be personalized in a variety of colours.

For many of those coming to the workshop, it is the first time they have had a custom-built mobility aid. They enter the workshop with assistance, but leave under their own steam.

The success of the project is largely due to the determined efforts of Project Director Edouard Norgho. He is a wheelchair user himself and so he fully appreciates the needs of his clients. Ouagadougou has more than two million inhabitants with no public transport systems, so Edouard makes sure that each wheelchair he makes is robust enough to cover long distances every day.

The five wheelchair makers at AMPO are all people with disabilities. Trained on the job, the workshop offers employment to people who often face discrimination on the labour market.

Spreading their expertise beyond the city, staff from the workshop travel further afield to reach up to 1600 people in rural areas. With the support of Rotary Germany the project receives funds and wheelchair parts, helping more and more polio survivors live a mobile life every year.

For the young girl in her new wheelchair, an exciting future awaits. In Burkina Faso more than 70% of children with disabilities have no access to education. Now, able to navigate to school by herself, she can become part of the 30% who do have the opportunity to learn. With the support of Rotary and other partners, AMPO is well on the way to helping more people like her, the target being to provide increased mobility to every polio survivor in Ouagadougou.

To find out more about this project, or provide financial support (US$250 will pay for a wheelchair for a child with disability), please visit sahel.org or contact info@sahel.de.

Edouard leads the workshop, creating custom wheelchairs for people affected by polio and other illnesses. ©Rotary
Edouard leads the workshop, creating custom wheelchairs for people affected by polio and other illnesses. ©Rotary
Children in Equatorial Guinea proudly show the dot of ink on their finger that demonstrates they have received a dose of oral polio vaccine.
Children in Equatorial Guinea proudly show the dot of ink on their finger that demonstrates they have received a dose of oral polio vaccine. ©UNICEF/Equatorial Guinea

This week, 18 countries across western and central Africa have been holding synchronised polio immunization campaigns to reach nearly 94 million children with oral polio vaccine (OPV). This is a monumental coordination effort, incorporating strong governmental commitment, global support from international organisations such as the World Health Organization and UNICEF and the motivation of members of communities themselves to mobilize their friends and neighbours to ensure every child is protected.

National Immunization Days in Angola, Benin, Burkina Faso, Cameroon, Central African Republic, Chad, Cote d’Ivoire, the Democratic Republic of the Congo, Equatorial Guinea, Gabon, Gambia, Ghana, Guinea Bissau, Mauritania, Niger, Nigeria, the Republic of the Congo and Senegal are working to build immunity across western and central Africa. Each child needs at least 3 doses of OPV to build immunity and end the transmission of the virus, making it crucial that campaigns such as this reach every child.

Africa is closer than ever before to achieving eradication, with only 22 cases across the continent to date in 2014 compared to 232 by the same point in 2013. This decrease of over 90% in one year is due to increased commitment from the governments of the last remaining endemic country in Africa, Nigeria, and the sites of current outbreaks in Cameroon, Equatorial Guinea, Somalia and Ethiopia.

Nigeria saw only 6 cases in 2014 compared to 53 in 2013 by this date. This dramatic improvement can be attributed to measures put in place to avoid missing children from campaigns, and to a surge in staff to the country to support Emergency Operations Centres. The international spread of polio, affecting Cameroon, Equatorial Guinea, Somalia and Ethiopia as well as countries in the Middle East, lead to the declaration of polio as a Public Health Emergency of International Concern (PHEIC) in May 2014 by the Director General of the World Health Organization. With temporary recommendations to stop the international spread of polio, the PHEIC is another step towards ensuring a polio-free Africa.

Through these measures – improved surveillance, innovative community engagement strategies and a surge in staff to affected areas – the past year has seen gains in the eradication effort that must be protected. Synchronized campaigns such as this bring us ever closer to the important milestone of ending transmission in Africa.
These synchronised campaigns demonstrate the commitment of the governments of countries across central and western Africa to ending the transmission of polio once and for all, despite the increased focus on Ebola prevention and response in 2014. In some cases, polio resources are being utilized to strengthen the Ebola response, demonstrating the Global Polio Eradication Initiative’s commitment to securing the polio infrastructure for a polio-free world.

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