24 October 2017, Addis Ababa: Today, as the world commemorates World Polio Day, we, the World Health Organization (WHO), UNICEF and Rotary International, reaffirm our commitment to building on the success of our joint polio eradication efforts and sustaining the polio free status of the country.
Today, we are looking back at nearly three decades of concerted global polio eradication efforts. The Global Polio Eradication Initiative was created in 1988 after the World Health Assembly resolved to eradicate poliomyelitis globally and has since made remarkable progress towards reaching the eradication target. As a result, polio cases globally decreased by over 99 per cent from an estimated 350,000 cases in 1988, to only 37 reported cases in 2016. Furthermore, the number of countries with polio endemic decreased from 125 to only three countries – Afghanistan, Nigeria and Pakistan. However, until the polio virus transmission is interrupted in these polio endemic countries, all countries remain at risk of polio importation.
Ethiopia maintained its polio-free status for almost four years (45 months) after the last wild polio case was reported in Somali region in January 2014. We recognize that this achievement is a result of the effective leadership of the Federal Ministry of Health and the great partnership of polio eradication initiative collaborators, donors and partners including:Rotary International; Bill and Melinda Gates Foundation; WHO; UNICEF; USAID; CDC; CORE Group; and many frontline health workers who have played a key role in the successful fight against polio.
We are committed to building on the recommendations which Ethiopia received from the Africa Regional Certification Commission (ARCC) in June 2017 when Ethiopia’s submission of a national polio free status report was accepted. As such, we will strive to strengthen and maintain routine immunization and surveillance with a particular focus on pastoralist communities, refugees, hard to reach and border areas as well as strengthening outbreak preparedness and coordination, cross-border surveillance with Somalia and others.
The theme for this year’s World Polio Day in Ethiopia is “Commending Ethiopia polio free status, sustaining the gain.” While we celebrate Ethiopia’s polio eradication success, we remain committed to continuing our joint polio eradication efforts in order to sustain this incredible achievement. In particular, we will build on the lessons learned as we strive to achieve regional certification.
The Polio Eradication and End Game Strategic Plan, developed by the Global Polio Eradication Initiative, envisages a polio free world by 2018. While we have come very close to achieving this goal, much remains to be done. We would like to call on all stakeholders to renew their commitment to a world which is free of polio.
Addis Ababa, 24 October 2016: Today, as the world commemorates World Polio Day, we, the Federal Ministry of Health, WHO, UNICEF and Rotary International, in collaboration with other stakeholders and partners, reaffirm our commitment to eradicate the polio virus once and for all from Ethiopia.
This year’s World Polio Day is about the birth of a vaccine against the polio virus and a celebration of 30 arduous years of Polio Eradication Initiative (PEI) journey. The Day also comes during a critical phase for the Global Polio Eradication Initiative (GPEI) with 99.9 per cent polio cases reduction since 1985.
In Ethiopia, it has been nearly three years since the wild polio virus transmission has been interrupted. However, the recent outbreak in Nigeria shows us that we need to be more vigilant and well prepared for a robust and rapid response to children and communities especially in high risk, inaccessible and insecure areas.
The success and the gains made in the polio eradication efforts would not have been possible without the strong leadership of the Federal Ministry of Health and the unprecedented support of stakeholders – WHO, UNICEF, Rotary International, NGOs, communities as well as donors including USAID, CDC, Bill and Melinda Gates Foundation and others.
Dr. Tadesse Alemu National PolioPlus Committee Chairman, Member African PolioPlus Committee reminds: “For 17 years we have done it greatly in Polio Eradication Initiative and I urge donors, partners, allies and health workers to increase the gains. I am confident that we will continue our effort together without fatigue. We must have strong push to ENDPOLIONOW and root out polio once and for all.
H.E. Dr. Kebede Worku State Minister of Health conveys in his message “Let’s flash back and remember with pride, the children we have saved from the crippling disease, polio; the strategies set, the activities implemented and the lessons learnt. What a gratifying element do we need to overcome our PEI fatigue? We don’t have a point of return but head on towards polio free world.”
“The World Health Organization will continue its support to the Ethiopian government to reassure the successful completion of ending polio and strengthen the sensitivity of the disease surveillance system to maintain gains beyond polio eradication,” said Dr Kalu Akpaka, Representative for WHO Ethiopia Country Office.
“UNICEF is highly committed to polio eradication efforts through its leading role in vaccine procurement, communication and social mobilization as well as its support to routine immunization. We will not stop until all children everywhere are consistently and routinely immunized against polio, the threat is real and obstacles remain on the road to zero cases. We must not let down our guard; we have to continue until there is not a single unvaccinated child,” said Gillian Mellsop, UNICEF Representative to Ethiopia.
As we commemorate World Polio Day this year alongside the 711st anniversary of the United Nations, we reflect upon the contribution of the polio eradication efforts to themes of development and human rights while we also envision further contributions to healthy generations and a brighter future. While celebrating the achievements made thus far, we re-commit to maximize our efforts as polio partners to bring a more significant contribution to the polio eradication efforts.
Even more ambitiously, we envision the polio eradication legacy as a contribution to the 2030 Sustainable Development Goals for equitable health and development for all children and communities. The possibilities are endless; the successes are at our fingertips. While we celebrate the remarkable progress to date and recognize the need to maintain this momentum, we understand the need to accelerate our efforts to work together for a polio-free Ethiopia. Yes- we will not stop until the job is done!
World Health Organization, UNICEF and Rotary International, on the occasion of World Polio Day 2015, renew their commitment to finish the race for polio eradication and secure a long-lasting legacy for a healthy Ethiopia
Addis Ababa, 23 October 2015 – Marking the occasion of World Polio Day 2015, the World Health Organization, UNICEF and Rotary International, jointly reaffirm their commitment to ensure Ethiopia joins all countries in a polio-free world by 2018 – the global target for polio eradication world-wide.
Ethiopia has been free of the wild-polio virus (WPV) for the last 21 months, since the last confirmed case in Ethiopia’s Somali Region. The 2013-2014 Horn of Africa (HOA) polio outbreak resulted in 223 WPV cases across Somalia, Kenya and Ethiopia combined. Out of this number, 10 WPV type-1 (WPV1) cases were reported in Ethiopia, all in the Somali Region. The HOA polio outbreak was a devastating setback for the region, Ethiopia as a country and its people.
Due to the aggressive and innovative response led by the Ethiopian Federal Ministry of Health (FMOH) and polio partners, the outbreak was declared successfully interrupted by national and international experts in June 2015. The last reported wild polio virus WPV on the entire continent of Africa was 14 months ago – with the last WPV1 case confirmed in neighboring Somalia in August 2014. While these successes are cause for celebration; we also underline the importance of sustained commitment at every level.
In an effort to maintain the momentum, we each play our part as polio partners and bring an important and unique contribution to the polio eradication efforts. “Thirty years ago, we told the world what Rotary believes: that we can achieve the eradication of only the second human disease in history. Our belief is close to becoming reality. For every child, let’s make sure that reality is a bright one. On 23 October, Rotary will host its third annual World Polio Day event,” states K.R. Ravindran Rotary International President in his friendly call to partners and allies to join World polio Day 2015.
WHO and UNICEF continue to prioritise quality polio supplementary immunisation activities (SIA); alongside sustained quality disease surveillance; coordination and technical assistance; social mobilisation; vaccine procurement; cold chain and logistic support. Routine immunisation, the backbone to polio prevention, is the flagship programme for FMOH, WHO, UNICEF and other partners.
The National Routine Immunization Improvement Plan 2014-2016, with the objective to achieve national Penta 3 coverage of 95 per cent by 2016, provides focused support to 51 zones, home to the vast majority of unimmunized children of the country.
“In the spirit of the polio legacy, we as UNICEF and as a global polio eradication partner, are working together towards a country with a strong routine immunization system, to protect all children, everywhere against polio and vaccine preventable diseases, paving the way for a better future for all,” states Patrizia DiGiovanni, Officer in Charge of UNICEF Ethiopia.
As we commemorate World Polio Day 2015 alongside the 70th anniversary of the United Nations, we reflect upon and celebrate the polio eradication initiative contribution to themes of development and human rights; and we envision further contributions to an even brighter future. Closing out 2015 we celebrate together in recognising Ethiopia’s achievements made towards the Millennium Development Goals particularly the reduction of under-five mortality; and we look towards a polio-free world by 2018.
WHO Representative, Dr Pierre M’pele Kilebou affirms, “WHO is proud of its contribution towards the success attained so far in achieving MDG 4, interruption of WPV transmission and routine immunization improvement; and our efforts would continue to sustain the gain that Ethiopia have realized.”
Even more ambitiously, we all envision the polio eradication legacy contribution to the 2030 Sustainable Development Goals for equitable health and development for all children and families. The possibilities are endless; the successes are at our fingertips. In partnership, we are almost there. We will continue to work together for a polio-free Ethiopia until the job is done. And then we will keep going.
AWBARE, Somali region– Ermias Amare and Salah Kedir, health workers in Ethiopia’s Somali region, zip through the arid plains kicking up a trail of dust as they ride their motorcycle to the next settlement where they will be administering polio vaccines to children under the age of 5 years.
It is campaign time in Ethiopia’s Somali region, and the two health workers are on a mission that is critical for the well-being of Ethiopia’s children.
Ermias and Salah are taking part in the National Immunisation Days (NIDs) campaign, vaccinating children against polio with the oral polio vaccine (OPV) in the Somali region. Vaccination against polio is essential to prevention of this crippling, disabling and potentially fatal disease which, is easily contracted from person to person, and especially dangerous to individuals and populations when there is not sufficient immunity, or protection, against the virus. The consequences of polio disease are devastating, for a child, for a family, and for a community.
Most of the children in the village visited by Ermias and Salah have their finger marked with ink, indicating that they have already been vaccinated during this present campaign.
In August 2013, the Dollo zone of Somali region, in the southeastern corner of Ethiopia bordering Somalia, was hit by a polio outbreak. Tragically 10 children were paralysed as a result of wild poliovirus (WPV) infection. Since the beginning of the polio outbreak, 15 National and Sub-national Immunisation Days (NIDs/SNIDs), have been conducted to date to respond to the outbreak. The total number of WPV cases reported since the start of the outbreak remains at 10 – the last case confirmed 18 months ago. Maintaining the momentum of response efforts has been be critical to ensure no more polio cases are seen in Ethiopia.
Communication and social mobilisation efforts have been instrumental in the interruption of the WPV transmission in the Somali region. In Lafaisa kebele (sub-district) of Awbare (woreda) district, a town crier mobilizes the community through a megaphone to alert parents that children under the age of 5 years will be receiving polio vaccinations during the campaign.
Nearby, a village Sheikh, trained by the Somali Regional Health Bureau (SRHB) in partnership with UNICEF and the Islamic Affairs Supreme Council, gathers mothers and children for a discussion about the campaign where he explains the benefits of immunisation and urges them to have their children vaccinated. Among the strategies deployed by the SRHB and UNICEF to meet the need for information was to engage religious leaders to council the pastoralist communities, particularly women, about the importance of vaccinating their children, for every round. The eminent position that religious and clan leaders hold in pastoral Somali communities and their ability to mobilize the population, has become a key factor in the success of immunisation activities.
“In the past when we informed communities about upcoming campaigns, because they didn’t have an understanding about it, some would refuse to bring their children forward,” said Ermias. “There were many challenges. They would refuse to have their children vaccinated. But today, we vaccinated an infant who was born today. In the past, that would be unheard of. Now, if they have a child out at their farm when we come for the vaccinations, they will tell us we missed one and to come back the next day.”
Cross Border Vaccination
The success of the polio eradication efforts hinges on successful cross-border collaboration between neighbouring countries, such as Somalia and Kenya. Immunisation activities in Ethiopia’s Somali region are therefore held in coordination with health institutions across the borders. Border vaccination points have been set up, and all children under 15 years of age crossing the border receive polio vaccination.
“All the children under 15 years of age who cross the border from Ethiopia to Somaliland or the other way are vaccinated,” said Nemo Alele, head of the Awbare Health Center, located near the border with Somaliland. “This is a border area and we explain to the mothers very carefully what harm can happen if there is transmission of the disease. We have good relations with our counterparts in Somaliland and have discussions on a monthly basis.
There is a similar vaccination centre on the other side of the border where they are doing similar work, and we are both committed that no child should cross without being vaccinated.” Sophia Ege Bulale lives with her three month old grandson Hamad Mukhtar Dayib, in Lafaissa kebele. Sophia has been caring for her grandson ever since her daughter-in-law left Hamad with her son, who lives in Hargeisa in Somaliland, to raise on his own. “I travel back and forth between Lafaissa and Hargeisa with Hamad,” said Sophia. “We didn’t have these vaccinations when I was young and I have seen children who grew up disabled as a result of polio. I am therefore happy that vaccinators come to our house to make sure that my grandson will be protected, whether he is here or in Hargeisa.”
In February, the polio NID aimed to reach nearly 14 million children under the age of 5 years with OPV. According to the national administrative coverage, 99.7 per cent of children were reached with the polio vaccine nation-wide; and over 98 per cent in the Somali region. This is a remarkable achievement, particularly within the context of the highly mobile pastoralist communities of Somali region.
Mobile health and nutrition teams (MHNTs) have helped to reach communities with polio and routine vaccination. In the Somali region, 24 MHNTs operate to reach pastoralist and remote populations. The teams work 5-6 days a week in selected operational sites on a fixed schedule, and with the support of local social mobilizers who continuously inform the target community of the arrival of health teams. They reach over 1,000 clients per month, of whom, over 40 per cent are children under the age of 5 years.
Reaching all targeted children with the polio vaccine is neither an easy nor simple task. More than 90 million doses of the OPV were provided for all polio outbreak response campaigns to date. Much effort has been exerted by all stake holders to bring the polio vaccine from the manufacturer, to the vaccination teams, to the mouths of children, in a timely, safe and good condition to help protect every child against polio.
It is through the leadership of the Federal Ministry of Health and the generous support of polio donors such as the European Union, the Bill and Melinda Gates Foundation and Rotary International, and others that more children have been reached with the polio vaccine, and that interruption of the outbreak has been possible. In partnership, alongside health workers like Ermias and Salah, together, we can ensure polio transmission remains at zero in Ethiopia.
By Jasmine Pittenger, UNICEF consultant and writer
The patches that make up the nomad’s tent say it all. Yellow, orange and red cloth is sewn together with broad stitches — even a pair of trousers is sewn into the mix. Yet the tent is greater than the sum of its parts. It protects a large family from scorching desert sun, from cold nights and rain.
When a polio outbreak struck the Horn of Africa in 2013, WHO and UNICEF with the help of the European Union had to find a way to reach every last child across Somalia, Kenya and Ethiopia. It was a daunting task to deliver multiple doses of OPV (Oral Polio Vaccine) into the mouths of some of the world’s hardest-to-reach children – from war-torn parts of Somalia to the diverse landscapes of Kenya and Ethiopia. Among the very hardest-to-reach are nomads in Ethiopia’s Somali region, which shares a porous 1,600 kilometer border with Somalia. Here, over 80 per cent of the 5 million people are nomadic, herding cattle, camels and goats across broad stretches of desert in search of water and pasture. For many families, home is a tent sewn together from patches of cloth and carried from one watering hole to another on the back of a camel.
To end the outbreak, it was crucial to deliver messages to families constantly on the move. Yet only 11 per cent of people here have access to newspapers or radio. How, then, do you inform families about polio’s risks and the need for children to take OPV? What is the patchwork that makes up this particular community? How do the nomads themselves pass on life-saving information, and receive it? And who is in a position to mobilize families?
One answer is with the Sheikhs and Imams. The Somali Regional Health Bureau and UNICEF reached out to the Somali Region’s IASC (Islamic Affairs Supreme Council). This part of Ethiopia is close to 100 per cent Muslim, and the IASC Sheikhs and religious leaders, are amongst the most respected and influential personalities amongst nomadic communities here. The communities have faith and belief in what they say, and seek out their teachings even as they’re on the move. Once the highest-level Sheikhs and Imams became engaged in warning parents about polio’s risks and the need for OPV, Islamic leaders at all levels got on board.
“We have partnered with UNICEF and WHO because we believe this is a noble cause that is completely in line with our religion, Islam,” says Sheikh Abdel Rahman Hassan Hussein, President of the IASC in Jigjiga, capital of the Somali region. “From the city to the most remote villages, you will find every person working in this project motivated and doing his/her best. They know they are doing something that almighty Allah will reward them for, at the last day. They know they are saving the lives of children and their future by protecting them from this disease, polio. We take every occasion to tell people about this – from Friday prayers to feasts.”
Another answer: children themselves. Messages about polio and OPV are also being taught in schools, including the religious schools or madrassas that many children attend.
“How many drops of the polio vaccine must be taken, every time the vaccinators come, by each and every child in your home?” asks a teacher at a small IASC-run madrassa on the border with Somalia. “Two drops, two drops!” shout the school children. “How do you know when a child has been vaccinated?” “The finger! The mark on the pinkie finger!” Children clamor to show off where the ink-marks should go on their fingers. Children can be great transmitters of polio messages to their parents. Says 10-year-old schoolboy Hassan: “At home I tell my mother and father about the importance of immunisation to protect little ones under the age of five.”
Parents pay attention – especially when the messages their children bring home are backed up by their local Imams, clan leaders and female community mobilisers who work for polio eradication. In Lafa’isa kebele 04 in the Awbare woreda of the Somali Region, Mrs. Hibo Abdikarim Ibrahim, mother of one-and-a-half-year-old baby boy Mohamed-Amin Abdusalam Abdosh proudly shows his vaccination certificate:
“I am so happy my child is fully immunized now. Every National Immunisation Day I also immunize him to protect him from polio. I learned all of this from our lady community mobilizers and we heard the same message in the mosque.”
From Sheikh and Imam to female community mobiliser to clan leader from madrassa student to mother and baby – this is how a movement is built. Each forms a piece of the patchwork to protect children from polio. Just like each dose of polio vaccine, generously funded by the European Union, strengthens the immunity of the community.
Yet there is still much to be done. In the last campaign, 5 per cent of children reached were “zero dose” – they had never before received even a single dose of OPV. This is both hopeful, we are reaching children never reached before, and potentially troubling – are there further pockets of zero dose children we have not yet reached, who are entirely unprotected from polio? And while OPV and Routine Immunisation can go a long way toward protecting children from ten life-threatening, vaccine-preventable diseases, ongoing threats to child health and survival in Ethiopia’s Somali region, and across the Horn of Africa, are great.
Like the patches that make up the nomad’s tent, no single square of cloth is enough on its own. When we join together, from the Sheikh and Imam to the nomad to the international community, the whole is much greater than its parts. Together we can keep building a tent of protection to end polio and improve child health in the Horn of Africa – and to wipe the virus from the face of the earth for good. This can only be done with generous contributions from donors such as the European Union who have enabled the programme to reach the hardest to reach with life-saving polio vaccine.
Vigilance in Somalia and region still needed before the region is declared polio-free once more.
By Shalini Rozario
17 June 2015, Nairobi, Kenya. Government representatives, technical experts, donors, and polio partners gathered on Wednesday, 17 June 2015 to review the polio outbreak status in the Horn of Africa (HOA) Region. The final assessment concluded the following:
The assessment team commends the overall robust outbreak response in the HOA with strong vaccination, communication strategy and strengthened surveillance.
The assessment team believes that transmission in Kenya and Ethiopia has been interrupted; however, continued undetected low level transmission cannot be ruled out in Somalia
Overall progress in the region was reviewed since onset of the outbreak in April 2013, which resulted in a total of 223 WPV cases across the region (10 in Ethiopia), and remaining challenges ahead were identified. Chaired by the Horn of Africa polio Technical Advisory Group (TAG) Chair, Dr. Jean-Marc Olive, the meeting gave opportunity to strategically reflect on the current outbreak status and required next steps for all three countries. Dr. Ephrem Tekle, Director of the Maternal and Child Health Directorate, Ethiopia Federal Ministry of Health responded positively to the wild poliovirus (WPV) interruption in Ethiopia, and also acknowledged the work ahead to further improve routine immunisation. “Successes achieved in the polio response are due to the political commitment and the support of partners,” said Dr. Ephrem. “We have been successful on SIAs (supplementary immunisation activities) and NIDs (National Immunisation Days). However, I don’t think we are yet fully successful on routine immunisation; there is a lot to do on routine immunisation even though WPV transmission is interrupted.” Dr. Ephrem acknowledged the strong focus on the involvement of religious and clan leaders in the Somali Region, and mobilisation of the community which have been instrumental to some of the immense achievements in the polio legacy process. He cited an example of community leaders asking for a generator so they could continue routine immunisation services. In moving ahead, Dr. Ephrem stressed the importance of sustaining the polio gains made, using the momentum to improve routine immunisation in the country, and also emphasised the importance to intensify the same efforts in regions bordering South Sudan, such as Benshangul Gumuz and Gambella, in light of the immense population migration. The HOA TAG Chair congratulated Dr. Ephrem and the Ethiopia team on their efforts and wished the country success for strengthening routine immunisation in the country, a challenging task. Closing remarks were provided by governments and partners such as Rotary International, CDC, The Gates Foundation, Red Cross, Core Group, USAID, Communication Initiative, UNICEF, WHO and the HOA TAG Chairman. Next steps for countries include working towards the polio legacy transition plan and using polio assets and achievement to further strengthen routine immunisation and beyond. Countries will continue to implement specific recommendations from the external assessment team, and the outbreak response in Somalia will be assessed again after three months. Following the Somalia assessment, the next HOA TAG meeting in August, and continual monitoring of regional progress, it is hoped that soon, the entire HOA region will be declared “polio-free.”
Through the generous support of polio donors and partners such as the Centres for Disease Control and Prevention; Crown Prince Court, Abu Dhabi, UAE; European Union; the Bill and Melinda Gates Foundation; National Philanthropic Trust; Slim Foundation; Rotary International; Swedish International Development Cooperation; and others, successful interruption of the outbreak in Ethiopia has been achieved. Continued collaboration is critical to sustain gains for polio and routine immunisation for healthy children and families in Ethiopia.