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Michel Zaffran reflects on polio lessons and the job ahead | Devex.

[03 September 2020]

Michel Zaffran, outgoing director of the World Health Organization’s polio eradication program. Photo by: WHO

Jenny Lei Ravelo writes:

MANILA — Michel Zaffran is stepping down as director of the World Health Organization’s polio eradication program by the end of 2020, having reached the organization’s retirement age. But the French national is spending his last few months in office with his hands full.

In a conversation with Devex, Zaffran, who has led the organization’s polio program for the past five years, said there is ongoing work to make a novel oral polio vaccine available by fall. The vaccine will be used to respond to the outbreak of circulating vaccine-derived poliovirus type 2, replacing the monovalent type 2 oral polio vaccine currently in use. The goal is to make it available under emergency-use listing initially and supply the vaccine for free to countries experiencing outbreaks of vaccine-derived poliovirus type 2, such as Sudan.

But care will be taken to ensure no concomitant use of the new and old vaccines to avoid any misunderstandings of the impact of each vaccine.

“And then eventually, when we are reassured that the vaccine works well after its initial use in, I would say, half a dozen countries, then we'll be able to supply to any country that requests [it],” Zaffran said.

WHO and partners have also kick-started a process to revise the current global polio eradication strategy, which Zaffran said he hopes will be finished in time for the World Health Assembly in 2021.

The strategy requires fresh thinking in light of the challenges posed by and needs arising from COVID-19, and Zaffran said they will be looking for input from a range of stakeholders, such as behavioral scientists and civil society organizations that have not been previously involved in the development of the strategy.

While global polio eradication efforts have achieved significant milestones over the past three decades — the latest being the certification of the WHO African region as free of wild poliovirus — significant barriers remain to global polio eradication. There have been increases of wild poliovirus type 1 cases in Pakistan and Afghanistan and outbreaks of vaccine-derived poliovirus in several countries, such as the Philippines.

Early in the year, the Global Polio Eradication Initiative postponed polio vaccination campaigns amid the risk of COVID-19 transmission and repurposed polio infrastructure in countries to support governments’ efforts against the pandemic, leading to a rise in polio cases.

“We're thinking that perhaps the restriction of movements and sort of the fact that people were being [in lockdown] could actually sort of slow down the spread, [but the] impact has been negligible,” he said. “We have more children vulnerable because they haven't been vaccinated, and not only vulnerable to polio, but vulnerable to many vaccine-preventable diseases.”

A new approach.

Part of what they want to achieve in the next strategy — and what other stakeholders could provide fresh thinking around — is getting communities to demand the vaccine themselves.

“We want to make it something that is less driven outside of the community and more demanded by the community. How do we make this happen?” Zaffran asked.

“If the communities want to vaccinate their children, then there's nothing that will prevent it. [But] at the moment, they're not really asking for this vaccination,” he added.

One of the biggest lessons he learned in years of leading global polio eradication efforts is the importance of getting communities to own the response, as was the case in India, which was declared polio-free in 2014 after years of accounting for the majority of the world’s polio cases.

“I think we probably have underestimated — at least with the two remaining [polio endemic countries of Pakistan and Afghanistan] and with this resistance to finish the job of vaccinating — the need for engaging the countries and the communities in doing the job themselves,” Zaffran said.

The world is now wild poliovirus type 3 free, but experts warn the job is not yet done

"Complacency is one of our biggest dangers now," says Oliver Rosenbauer, WHO communications officer and spokesperson for the Global Polio Eradication Initiative.

“We thought that we could convince those communities to finish the job and the virus would disappear. Unfortunately … many things have played against us,” he said, noting that the hard push for polio eradication needs to be sufficiently combined with engaging communities to the point that they champion the goal themselves.

Part of the challenge is the circulation of rumors and fake news, which leads to vaccine hesitancy, as was the case in Pakistan in 2019 when a rumor spread that the polio vaccine was killing children. The other challenges are community engagement and the absence of other basic but essential community needs, Zaffran said — a situation evident among Pashtun communities in Pakistan. Tensions with the government and the lack of basic needs and services have created a sense of resentment among communities.

“For them, seeing the health workers come with drops of polio, when in fact the children were suffering from lack of access to water or lack of access to other vaccines, perhaps … created a bit of resentment,” the WHO polio director said.

He said they are now trying to integrate vaccination for other vaccine-preventable diseases in their anti-polio drive and collaborate with other health programs. But he admits slow progress, as these activities require agreements and coordination with the government and other health services.

“The difficulty here is that it's always easier and faster to do it alone than to do it with others, but it's more important to do it with others if we want to really serve the needs of the community,” he said.

Video: Michel Zaffran, WHO director of polio eradication [5:05]

The future ahead

Zaffran said he will continue to be involved in polio even after his retirement by advocating and raising resources for polio and PolioPlus, an initiative by Rotary International that provides other interventions or assistance in support of polio eradication efforts.

“I am a Rotarian myself. I've joined Rotary myself in a small club in France, and I intend to continue to advocate for raising resources to support PolioPlus and the Rotary International efforts,” he said.

Polio eradication efforts under threat as vaccine campaigns halted

Money has been poured into winning the fight against polio, but those gains are now in a precarious position.

This will be much needed, given the financial challenge awaiting polio eradication efforts in 2021. While GPEI was able to raise $2.6 billion during a pledging conference in November 2019 in Abu Dhabi and some other pledges have come in since, Zaffran said the initiative is short of money.

“We actually are facing a very challenging situation for 2021. And we'll have to ... either be able to raise more resources or make some ... programmatic decisions that will be associated with some risks. We may decide to actually cut some areas of the program in order to be able to focus on [others],” he said, adding that these will be part of the discussions in revising the GPEI strategy.

GPEI had a funding gap of $500 million as of June 30. This is likely to increase, as additional time and precautions needed in carrying out polio vaccination campaigns amid the COVID-19 pandemic are likely to cost the program at least 10% more than what was budgeted, Zaffran said. But of the $2.6 billion in pledges from November, only 22% has been made available to date.


About the author

Jenny Lei Ravelo @JennyLeiRavelo

Jenny Lei Ravelo is a Devex Senior Reporter based in Manila. She covers global health, with a particular focus on the World Health Organization, and other development and humanitarian aid trends in Asia Pacific. Prior to Devex, she wrote for ABS-CBN, one of the largest broadcasting networks in the Philippines, and was a copy editor for various international scientific journals. She received her journalism degree from the University of Santo Tomas.

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Somalia Polio Flash Update: Week 34 2020 | ReliefWeb.

[Situation Report] [Sources: UNICEF WHO] [Posted: 5 Sep 2020] [Originally Published: 5 Sep 2020]

  • One case of circulating vaccine-derived poliovirus type 2 (cVDPV2) was reported this week, with date of onset on 18 July 2020. The affected child lives in an accessible village in Dharenkley district, Banadir region.

  • This is the third cVDPV2 case to be reported in Somalia in 2020. The case is genetically linked to the existing cVDPV2 outbreak in the country.

  • In total, 19 children with polio have been identified across Somalia since the initial detection of the ongoing cVDPV2 and cVDPV3 outbreaks in late 2017.

  • 19 cVDPV2 positive environmental samples have been reported so far in 2020.

  • This ongoing isolation of poliovirus from both the environment and cases suggests continuing transmission of cVDPV2 among the population.

  • Planning continues for the resumption of polio immunization campaigns, which were paused across the country in light of the ongoing COVID-19 outbreak. From 30 August to 1 September, an integrated polio and measles campaign went ahead at fixed and outreach sites, aiming to boost the immunity of 400,000 under-fives. The campaign delivered vitamin A and deworming medication alongside vaccines.

  • The polio teams are monitoring the COVID-19 situation closely to ensure that implementation of mOPV2 case response, which has been postponed since March 2020, can resume in safe conditions.

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Yemen - Complex Emergency Fact Sheet #11, Fiscal Year (FY) 2020 | ReliefWeb.

[Situation Report] [Source: USAID] [Posted: 4 Sep 2020] [Originally Published: 4 Sep 2020]

  • USG partners provide emergency assistance to households adversely affected by heavy rains and flooding during July and August.

  • Fuel shortages and price increases result in temporary reductions of humanitarian assistance for hundreds of thousands of people in August.

  • Escalated conflict in Al Jawf and Marib governorates displaces nearly 11,000 households to date in 2020.

  • WFP reports that nearly 40 percent of Yemeni households remained without access to adequate, nutritious food on a regular basis as of mid-July.


Floods Result in Casualties, Damage, and Displacement Across Yemen.

Heavy seasonal rains and flooding in July and August had affected an estimated 435,000 people across Yemen as of August 29, compounding the effects of previous rain and flooding events during April and June, the UN reports. The recent floods resulted in more than 250 casualties—including 131 deaths—in northern Yemen, according to the Sana’a-based Ministry of Public Health and Population; the floods also damaged and destroyed food and household items, internally displaced person (IDP) sites, and roads, hindering civilian and humanitarian movement. The International Organization for Migration (IOM) recorded nearly 1,200 displaced households in Al Hudaydah Governorate and approximately 60 displaced households in Marib due to the floods from late July to early August, while flooding dislodged some explosive remnants of war and landmines to previously hazard-free areas, the UN reports. In addition, relief actors have expressed concern regarding the health impacts of the floods, particularly the heightened transmission risk of vector-borne and waterborne diseases amid Yemen’s ongoing cholera outbreak.

In response, humanitarian organizations—including U.S. Government (USG) partners—have conducted assessments of flood-related impacts and provided food, health, shelter, and water, sanitation, and hygiene (WASH) assistance to affected communities. With USG and other donor support, IOM distributed more than 2,900 emergency shelter kits in Aden, Hajjah, and Al Hudaydah governorates and provided shelter support to nearly 2,500 affected households in Marib. USAID/BHA partner the UN World Food Program (WFP) distributed food and hygiene items to more than 2,500 households across 11 governorates through the USAID/BHA-supported Rapid Response Mechanism (RRM)—which provides recently displaced populations with immediate food, water, and hygiene assistance within 72 hours of displacement—and provided in-kind food assistance to approximately 2,800 households in Amran, Dhamar, and Marib governorates. Additionally, the UN World Health Organization (WHO) is augmenting the availability of antimalarial drugs, cholera kits, and disease screening services at health facilities in affected areas to mitigate the adverse health impacts of the floods.

Ongoing Fuel Crisis Prompts Reductions of Relief Activities in Yemen.

The fuel crisis in northern Yemen continues to adversely affect relief operations, with historically low fuel imports in June resulting in increased fuel prices and hampered civilian and humanitarian movement, according to the UN. While the UN Verification and Inspection Mechanism for Yemen reports that fuel import levels into Yemen’s Red Sea Ports rose from only 8,100 metric tons (MT) in June to nearly 133,000 MT in July, the price of gas and diesel increased by approximately 100 and 50 percent, respectively, from mid-June to mid-July due to the impact of the June deficit on the supply chain, WFP reports. The fuel shortage and resultant price increases have inflated essential commodity and transportation costs, hindering relief activities, including food distributions, health and protection services, and the provision of safe drinking water, according to the UN. As of late July, the fuel crisis had prompted relief actors to temporarily reduce or suspend WASH services to nearly 259,000 households and protection interventions supporting more than 41,000 households across Yemen, as well as shelter and settlements support for approximately 26,000 households in Ad Dali’,
Hajjah, Ibb, and Ta’izz governorates, the UN reports. Shortages also resulted in delayed or blocked food distributions for nearly 38,000 people in Hajjah, Al Hudaydah, and Marib, while adversely affecting nearly 200 health facilities supported by the Health Cluster.

WHO is delivering fuel to health facilities across the country to support the continuity of life-saving health care services in Yemen. In addition, a USAID/BHA international non-governmental organization

(INGO) partner is providing humanitarian coordination and information management (HCIM) support to relief actors by analyzing and mapping the impact of fuel shortages on operations to bolster humanitarian decision-making.

Clashes in Al Jawf, Marib Displace Nearly 1,000 Households in Late August.

Escalated conflict in northern Yemen’s Al Jawf and Marib, which began in late January, continues to displace populations and increase humanitarian needs, according to the UN. In late August, IOM recorded approximately 830 and 150 newly displaced households in Al Jawf and Marib, respectively, due to increased fighting in the governorates, bringing the total number of newly displaced households in Al Jawf to approximately 1,560 and Marib to 9,400 to date in 2020. While Marib remains a primary destination for IDPs fleeing frontline clashes, conflict continued to affect civilian areas in the governorate in late August, with airstrikes and shelling damaging civilian houses and water supply systems, the Protection Cluster reports.

With USG and other donor support, IOM is providing life-saving health, protection, and WASH support to IDPs and migrants—primarily from the Horn of Africa—in Marib. From late July to late August, IOM provided emergency health services to approximately 2,200 IDPs, conducted more than 5,300 protection screening interviews for IDPs and migrants, and distributed more than 400 RRM kits to newly displaced persons in the governorate. In addition, IOM distributed dignity and hygiene kits to approximately 1,000 and 2,000 migrants, respectively, to decrease the transmission risk of communicable diseases.

Economic Crisis, Conflict, COVID-19 Result in Worsened Food Insecurity.

Deteriorating macroeconomic conditions in Yemen—compounded by ongoing conflict and the country’s COVID-19 outbreak—continue to exacerbate the world’s largest food security crisis and constrain access to basic goods and services, WFP reports. From early January to mid-July, the Yemeni riyal (YER) depreciated by nearly 20 percent in Republic of Yemen Government (RoYG)-controlled areas; alongside other economic shocks, the YER’s depreciation resulted in a nearly 20 percent increase in the price of essential food commodities countrywide during the period. Meanwhile, COVID-19-related reductions in livelihoods and market access have decreased household income and ability to obtain adequate food , as prices of staple foods have risen. As a result, nearly 40 percent of Yemeni households remained without access to adequate, nutritious food on a regular basis as of mid-July, particularly in conflict-affected governorates such as Abyan, Al Jawf, and Marib, according to WFP.

WHO Confirms Poliovirus Outbreak in Sa’dah Governorate.

WHO confirmed an outbreak of circulating vaccine-derived poliovirus type one (cVDPV1)—a rare virus mutated from the weakened virus contained in oral polio vaccine (OPV) that can occur in underimmunized populations—in northern Yemen’s Sa’dah Governorate in early August, primarily affecting children ages eight months–13 years. The disease likely spread due to insufficient routine or supplementary immunization activities, with the affected children having only received zero to two OPV doses compared with the four-dose recommended schedule, WHO reports. Despite continued insecurity and related access constraints in the governorate, the UN Children’s Fund (UNICEF) and WHO plan to launch OPV campaigns in the coming weeks to stop the spread of cVDPV1 in affected areas.

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Angola: Polio vaccination campaign to reach over 400,000 children in Benguela | ReliefWeb.

[News and Press Release] [Source: Govt. Angola] [Posted: 2 Sep 2020] [Originally Published: 2 Sep 2020] [Origin: View original]

Benguela - Benguela province will vaccinate 419,419 children from zero to five years of age against polio, from 4 to 6 September this year, said Tuesday in this city the provincial public health supervisor Américo Máquina.

According to the public health specialist, who was speaking to Angop, 373,645 other children from nine months to five years of age will be vaccinated against measles and rubella in the municipalities of Cubal, Catumbela and Caimbambo, where there are still active cases of these diseases.

To boost the immune capacity of the small ones, he said, the Health Ministry decided to administer the "oral bivalent polio" vaccine with the inclusion of vitamin A, as well as injectable polio.

Although the vaccines have almost the same action in practice, injectable polio is more recommended for children who have never been vaccinated before in their life, being given from two months to less than five years of age.

In the specific case of the city of Benguela, he recalled that it has already carried out the blocking campaign, so this time, it should be left to oral polio and vitamin A administration.

He called on parents to bring their children's vaccination cards during the campaign to better control those who have already received the injectable polio vaccine.

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Nigeria: Enugu records 100% success in target polio vaccination ― Official | Vanguard Newspapers.

[SEPTEMBER 2, 202012:00 PM]

The Enugu Government has achieved 100 per cent success coverage in the just concluded ‘specific-target’ polio vaccination in the state.

Dr George Ugwu, Executive-Secretary of Enugu State Primary Health Care Development Agency (ENS-PHCDA), disclosed this while speaking with the News Agency of Nigeria (NAN) on Wednesday  in Uzo-Uwani Local Government Area of Enugu State.

NAN reports that the state embarked on six-day specific-target polio vaccination in 16 wards within the Uzo-Uwani council area between Aug. 22 and Aug. 27.

The exercise is targeted at vaccinating 35,775 children from three months to five years.

Ugwu said that the exercise was an overwhelming success and the targeted 35,775 children for the vaccination was exceeded and “we got 37,852 which is above 100 per cent’’.

The executive secretary said that the agency had not achieved such a resounding target in a single specific-target polio vaccination exercise.

He said the exercise enjoyed the maximum support of all relevant individuals and organisations, including the council chairman, workers, traditional rulers, religious leaders and community-based organisations.

The executive secretary noted that the exercise had to be extended for an additional two days to allow for effective and proper coverage of wards in difficult terrains.

“We recorded coverage of 100 per cent in Oral Polio Vaccination (OPV) and 96 per cent in the Fractional Inactivated Polio Vaccine (FIPV) in the just-concluded immunisation.

“The agency enjoyed robust cooperation from the chairman of the council area that also ensured that other leaders and workers within the council area supported us to attain the success,’’ he said.

Ugwu, however, said that the agency encountered few challenges during the exercise and that these centred on logistics and nature of the terrain.

“We were able to overcome these challenges by involving more hands, more vaccination teams, additional two State Technical Facilitators (STFs) and ensure very close supervision and dedication of all involved in the exercise.

“Of course, we have to extend the exercise for two additional days for effective mop-up and ensuring no child under the age range for the exercise is omitted,’’ he said.

The executive-secretary commended Gov. Ifeanyi Ugwuanyi for the support he gave the agency, especially in the just-concluded polio vaccination exercise.

“I also laud National Primary Health Care Development Agency, WHO, UNICEF as well as Rotary International, Association of Local Government of Nigeria, chairman of Uzo-Uwani council area and other stakeholders for their support to the exercise’’.


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