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A multibillion-dollar plan to end polio soon

As the world adjusts to the idea of ​​co-existing with the coronavirus for the foreseeable future, global health organizations are drawing up plans to eradicate another scourge that has remained for thousands of years: the poliovirus.

The Global Polio Eradication Initiative, a public-private partnership led by national governments and health groups, announced on Wednesday a $ 5.1 billion polio eradication plan by 2026.

Polio can cripple or even kill those affected. For decades, the initiative has sought to achieve a polio-free world by immunizing every child against the virus, but with limited success.

Many countries dealt with sporadic polio outbreaks before the onset of the coronavirus, but the pandemic halted some polio vaccination programs for at least a few months and worsened the trend. Last year, there were 1,226 cases of polio in the world, compared to 138 in 2018.

There was also some good news. In August, African countries were declared free of wild poliovirus, leaving Afghanistan and Pakistan the only two countries where polio is endemic. And in November, the World Health Organization issued the first emergency permit for a new vaccine that promises to minimize outbreaks of polio.

“Now is the time to double down and really make sure we stop the transmission and are able to provide a polio-free world,” said John Vertefey, head of the polio eradication branch at the Centers for Disease Control and Prevention. one of the partners in the global initiative.

Previous efforts to end polio have been hampered by inadequate funding and a lack of political commitment, factors that may now be an even more difficult challenge as Covid-19 continues to focus attention and resources.

The new strategy includes policies designed to increase political engagement while taking into account the pandemic, Dr Vertefey said. It covers two key objectives: integrating polio programs with other health programs and focusing on areas with chronically low levels of immunization. The plan also provides for the supply of vaccines and outlines a communication strategy to increase vaccine intake.

The plan’s architects consulted with more than 40 civil society organizations, academic institutions and donors to help them integrate polio eradication with other health challenges.

Attempting to engage communities in regions where there is hesitation or even hostility to vaccines is “obviously easier said than done, but at least I think it’s in the right direction,” said Dr. Walter Orenstein, associate director. of the Emory Vaccine Center and former director of the U.S. immunization program.

Dr. Orenstein was optimistic about the new strategy in general, and in particular the tactics of combining polio with other health programs to gain political support.

“Eradication is a very irreconcilable goal – one infection is one infection too many,” he said. But the new plan “clearly shows that they take into account the lessons they have learned.”

From March to July last year, polio immunization campaigns were suspended in more than 30 countries, leading to more unvaccinated children and more outbreaks of polio vaccine.

The oral polio vaccine, which is currently widely used, contains a weakened strain of the virus. Children immunized with this vaccine can transmit the virus to the environment through their faeces; from there it can infect unprotected people. As the virus passes from one unvaccinated person to another, genetic changes can cause it to return to a form that can cause paralysis.

About 90 percent of polio outbreaks are the result of this vaccine-induced poliovirus. In 2020, more than 1,000 cases were detected in 29 countries, far more than in previous years. A new oral vaccine, introduced in November, aims to make the virus more genetically stable and is thought to minimize the risk of vaccine-induced cases.

“It’s not a magic bullet that will solve all our problems – vaccines still have to reach people in order for them to work,” said Simona Zipurski, WHO’s polio eradication adviser. “But we think it will really help us sustain these outbreaks.”

The new vaccine is only approved for emergency use and eligible countries must commit to monitoring its safety and effectiveness. More than 20 million doses have already been distributed.

Outbreaks of wild poliovirus – the original plague – now occur only in Pakistan and Afghanistan. Since 2018, vaccination campaigns have missed about 3 million children in Afghanistan due to the Taliban’s ban on house-to-house immunization. The majority of outbreaks in Afghanistan in 2019 and 2020 originated in these areas.

“Understanding how we can access them through dialogue with them remains a critical focus of the program,” Dr Vertefey said, referring to the Taliban.

In Pakistan, Pashto-speaking communities near the Afghan border make up about 15 percent of the country’s population, but more than 80 percent of cases of wild polio. Vaccination fluctuations and misinformation spread through social media have led to an increase in cases since 2018.

“These problems have certainly been there before, and Covid pauses, allowing the number of cases to increase quite dramatically, quite rapidly,” said Dr. Vertefeuille.

Polio eradication programs will focus on immunizing hard-to-reach communities in both countries and training older women health workers who are more successful in persuading caregivers to vaccinate their children.

The global initiative has set up two teams to respond to outbreaks within 72 hours: one in the Eastern Mediterranean region (covering 21 countries, including Pakistan and Afghanistan) and the other in sub-Saharan Africa. This time, the strategy also includes health ministers in the Eastern Mediterranean region, so governments are urged to focus on polio from their peers rather than a global health organization.

“Eradication remains a key health priority,” said Dr. Faisal Sultan, Special Assistant to the Prime Minister of Pakistan. “We look forward to working with international partners to achieve a polio-free world.”

Nigeria, another country where polio is endemic, was declared polio-free last June after tackling some of the same challenges. The commitment of political leaders at all levels of government – including their grandchildren – to be vaccinated on television – has turned things around.

To restore polio as a priority, even in the face of competitive health challenges in these countries with money, government officials stress that polio programs can also be used to return Covid-19 and other diseases, Dr. Vertefeuille said: “This allows you to be prepared for any emergency. “

During the coronavirus pandemic, more than 31,000 poliomyelitis in more than 30 countries focused on monitoring Covid-19, tracking contacts, allocating supplies for hand hygiene, and training medical personnel and front-line workers.

In Pakistan, polio laboratories provided coronavirus testing and consistency, and the polio hotline became the national information center for Covid-19. Polio workers have trained nearly 19,000 health workers and hired 7,000 religious leaders and 26,000 influencers.

In Nigeria, health workers used data and analysis systems designed for polio to track health needs for Covid-19. Polio workers were also helpful during the Ebola outbreak in Nigeria.

In Pakistan and Afghanistan, polio immunization comes with other vaccines or other health needs, such as vitamin A and deworming tablets. Polio workers can also combine their immunization efforts with the supply of Covid-19 vaccines, although children vaccinated for polio are too young for coronavirus vaccines.

At the same time, confusion over Covid-19 vaccines has affected polio immunization campaigns, said Melissa Korkum, senior polio outbreak response manager at Unicef. Polio workers “need to spend much more time training and communicating on the doorstep with parents and carers,” she said.

In Nigeria, the first country to introduce the new polio vaccine, the immunization campaign began “almost in parallel with their release in Covid, it may have been on exactly the same days and slightly different areas,” Ms Zipursky said.

Polio faces many questions and concerns about the two vaccines, she said, stressing the need to be prepared with the right information. That was a really good lesson.

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