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Tuesday, August 11, 2015

Is Africa polio-free?

One year since the last case of wild polio on the African continent, we look at what needs to be done to turn this small step into a victory lap against polio.

Women at a community engagement event in Tharaka Nithi, Kenya, sing to remind parents about the importance of vaccinating their children to protect them against polio. While a year without a detected case of wild polio in Africa is an incredible achievement, there is much still to do.
Women at a community engagement event in Tharaka Nithi, Kenya, sing to remind parents about the importance of vaccinating their children to protect them against polio. While a year without a detected case of wild polio in Africa is an incredible achievement, there is much still to do.
©WHO/LDore
The 11 August 2015 marks one year without a case of wild polio confirmed on the African continent for the first time in history. Recent outbreaks in the Horn and Central Africa appear to have been stopped, and on 24 July, Africa’s last polio-endemic country, Nigeria, reached one year without a reported case.

However, Dr Hamid Jafari, Director of the Global Polio Eradication Initiative at WHO, warns that there is nothing magic about the one year marker. “Surveillance for poliovirus has improved considerably. However, in the past we have had year-long periods when we thought the poliovirus had gone from the Horn of Africa and central Africa, only to find out that we were simply missing transmission because our surveillance systems were not strong enough to spot cases. I am in awe of the governments, partners, community and religious leaders, health workers and volunteers who have brought us so far- and I ask them to keep up the commitment for the hurdles we still have to cross in Africa.”

To end polio forever in all countries of the world, there are several tasks that still need the commitment of all stakeholders in the programme:

Strengthening Acute Flaccid Paralysis Surveillance

Surveillance systems need to be strong enough to pick up on every single case of acute flaccid paralysis (AFP) and ensure it is tested for polio in order to be 100 % sure that it is caused by something else, otherwise the threat of polio cannot be ignored. This is why strengthening surveillance plays such an important role in closing polio outbreaks. 

In the Horn of Africa, where the outbreak in 2013 and 2014 paralysed 223 children, no wild poliovirus has been detected since August 2014. However, there are still some areas where low level of transmission cannot be ruled out, said Dr Hemant Shukla, who supports polio eradication for the Horn of Africa at WHO. “One year with no reported cases of polio is great news, but this progress needs to be treated with caution- a lot of very hard work is needed before we can be fully confident that polio is gone from the Horn of Africa,” he warned.

Reaching missed children

While strong surveillance ensures that we find every last virus, vaccination campaigns are essential to reach every last child with vaccines.

Pockets of un- or under- immunized children continue to exist across Africa, especially where insecurity makes campaigns a significant challenge, as in Yemen, Somalia, South Sudan and many other areas. Since the 2013 outbreaks in central Africa and the Horn of Africa, programmatic innovations have enabled more children to be reached than ever before. “Strategies such as transit vaccination posts set up around areas of insecurity, so that families leaving the area get the vaccinations they need, helped to reach some of the children missed by vaccines,” said Dr Shukla.
Despite this progress, there are still children being missed; and while polio continues to exist in Afghanistan and Pakistan, any child without the vaccine is vulnerable, should the virus spread. Continuing to increase the number of children reached through campaigns remains a top priority.

Routine Immunization

Efforts to end polio across the African continent have created a sturdy infrastructure to reach all children with life-saving vaccines and support other critical health priorities – an infrastructure that must be further built upon even after polio is eradicated. As we move closer to a polio-free world, the global community has an opportunity and an obligation to build a better future by applying the lessons learned and infrastructure from eradicating polio to other global health priorities, including routine immunization. GPEI staff are focussing on supporting routine immunization strengthening in particular in 10 priority countries, 7 of which are in Africa: Angola, Chad, DRC, Ethiopia, Nigeria, Somalia and South Sudan, by partnering notably with such organizations as Gavi, the Vaccine Alliance. Strengthening routine immunization in these countries will help to reach the significant numbers of children who remain unvaccinated there, giving the poliovirus less opportunity than ever to circulate.

Strong Leadership

African leadership has been instrumental in achieving a year without wild polio in Africa. For twenty years, the African Union's "Kick Polio out of Africa" campaign has driven progress against the disease, and recent declarations in support of eradication from the African Union Heads of State Summit and the Organization of Islamic Cooperation Foreign Ministers’ Conference recognize the sustained commitment needed to finish the job. Read the African Union Declaration on Polio Eradication and the Organization of Islamic Cooperation’s Resolution on Health Matters .

The contributions of Canada, the European Commission, Germany, Saudi Arabia, the United Arab Emirates and the United Kingdom have been key and continued international support will be essential to achieve a polio-free Africa. There is still significant work ahead to improve vaccination campaign quality and surveillance, particularly in the Horn and Central Africa.