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As the world adjusts to the idea of coexisting with the coronavirus for the foreseeable future, global health organizations are making plans to end another scourge that has been around for thousands of years: poliovirus.
The Global Polio Eradication Initiative, a public-private partnership led by national governments and health groups, unveiled a $ 5.1 billion plan to eradicate polio by 2026 on Wednesday.
Polio can cripple or even kill people who are sick. For decades, this initiative has tried to achieve a polio-free world by immunizing every child against the virus, with limited success.
Many countries dealt with sporadic polio outbreaks before the advent of the coronavirus, but the pandemic has halted some polio vaccination programs for at least a few months and exacerbated the trend. There were 1,226 polio cases worldwide last year, up from 138 in 2018.
There was good news, too. In August, African countries were declared free of wild poliovirus, leaving Afghanistan and Pakistan as the only countries where polio is endemic. And in November, the World Health Organization gave the first emergency approval for a new vaccine that promises to minimize polio outbreaks.
“It’s time to redouble our efforts and really make sure we stop transmission and can create a polio-free world,” said John Vertefey, head of the polio eradication unit at the Centers for Disease Control and Prevention. one of the partners of the global initiative.
Previous efforts to eradicate polio have been constrained by inadequate funding and lack of political commitment – factors that could become an even bigger problem now that COVID-19 continues to divert attention and resources.
The new strategy includes policies to increase political commitment in the face of the pandemic, Vertefey said. It has two key goals: linking polio programs with other health programs and focusing on areas of chronically low immunization rates. The plan also provides for the supply of vaccines and describes a communication strategy to increase acceptance of the vaccine.
The plan’s authors consulted with over 40 civil society organizations, academia and donors to help them integrate polio eradication with other health concerns.
Trying to engage communities in areas where there is uncertainty or even hostility towards vaccines is “obviously easier said than done, but at least in my opinion this is the right direction,” said Dr. Walter Orenstein, Associate Director Emory Vaccine Center and former director of the US Immunization Program.
Orenstein was optimistic about the new strategy in general, and especially the tactics of combining polio with other health programs to gain political support.
“Eradication is a very unforgiving goal: one infection is one infection, which is too much,” he said. But the new plan “made it clear that they are taking into account the lessons learned.”
From March to July last year, polio immunization campaigns were suspended in more than 30 countries, leading to an increase in unvaccinated children and an increase in outbreaks of vaccine-derived polio.
The currently widely used oral polio vaccine contains an attenuated strain of the virus. Children immunized with this vaccine can transmit the virus to the environment through faeces; from there it can infect unprotected people. When the virus is passed from one unvaccinated person to another, genetic changes can cause it to return to a form that can cause paralysis.
About 90% of polio outbreaks are the result of vaccine-induced poliovirus. In 2020, more than 1000 cases of the disease were detected in 29 countries, which is much more than in previous years. A new oral vaccine, introduced in November, aims to make the virus more genetically stable and is believed to minimize the risk of infection caused by vaccination.
“This is not a magic bullet that will solve all our problems – vaccines still have to reach people in order for them to work,” said Simona Zipursky, WHO polio eradication adviser. “But we really feel like it will really help us stop these outbreaks in a sustainable way.”
The new vaccine is approved for emergency use only, 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 scourge – are now occurring only in Pakistan and Afghanistan. Since 2018, vaccination campaigns in Afghanistan have missed about 3 million children due to the Taliban’s ban on immunization at home. The vast majority of outbreaks in Afghanistan in 2019 and 2020 originated in these areas.
“Understanding how we can gain access through dialogue with them remains a critical area of the program,” Vertefey said, referring to the Taliban.
In Pakistan, Pashto-speaking communities near the Afghan border account for about 15% of the country’s population, but more than 80% of wild polio cases. Uncertainty about vaccinations and the spread of misinformation through social media have led to an increase in the number of cases since 2018.
“These problems, of course, have existed before, and the pauses associated with COVID allowed a fairly sharp and fairly rapid increase in the number of cases,” said Vertefei.
Polio eradication programs will focus on immunizing hard-to-reach communities in the two countries and training older women health workers who are more successful in convincing caregivers to vaccinate their children.
The Global Initiative has established two 72-hour outbreak response teams, one in the Eastern Mediterranean region (which includes 21 countries, including Pakistan and Afghanistan) and the other in sub-Saharan Africa. This time, health ministers from the Eastern Mediterranean region are also involved in the strategy, so governments are urged to focus on polio by their peers rather than the global health organization.
“Eradication of the disease remains a top health priority,” said Dr. Faisal Sultan, Pakistani Prime Minister’s Special Assistant for Health. “We look forward to working with international partners to create a polio-free world.”
Nigeria, another country where polio was endemic, was declared polio free last June after addressing some of the same problems. The commitment of political leaders at all levels of government – including the vaccination of their grandchildren on television – has turned the tide.
To restore polio as a priority, Wertefeuil said, even with competing health concerns in these poor countries, officials stress polio programs can also be used to help reverse COVID-19 and other diseases. … ready for any emergency. “
During the coronavirus pandemic, more than 31,000 polio workers in more than 30 countries engaged in COVID-19 surveillance, contact tracing, hand hygiene distribution, and training for medical staff and frontline workers. In Pakistan, polio laboratories provided testing and sequencing for coronavirus, and a polio telephone line became the national clearinghouse for COVID-19 information. Polio staff trained nearly 19,000 health workers and recruited 7,000 religious leaders and 26,000 influential people.
In Nigeria, healthcare providers used data systems and analytics tuned for polio to track COVID-19 health care needs. Polio staff also helped during the Ebola outbreak in Nigeria.
In Pakistan and Afghanistan, polio immunization was combined with the delivery of other vaccines or other essential items such as vitamin A and deworming tablets. Polio workers can also combine their immunization efforts with COVID-19 vaccine delivery, even if the polio-vaccinated children are too young to be vaccinated against the coronavirus.
At the same time, the COVID-19 vaccine confusion has impacted polio immunization campaigns, said Melissa Korkum, senior polio outbreak response manager at UNICEF. Polio workers, she said, “have to spend a lot more time learning and communicating on the doorstep with parents and guardians.”
In Nigeria, the first country to introduce a new polio vaccine, the immunization campaign began “almost parallel to the COVID rollout, perhaps in fact it happened on the exact same days and in slightly different regions,” Zipursky said.
Polio workers faced many questions and concerns about the two vaccines, she said, highlighting the need to prepare the right information. “It was a really good lesson.”
This article originally appeared in New York Times…
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