Joining hands to ensure polio transmission remains at zero in Ethiopia

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.

Salah Kedir, clinical nurse (left), fills out vaccination records outside the hut of Sophia Abdi in Dudejirma sub-district, Rer Hassen Settlement,Tulugulid District, Fafan Zone. Three year old Sehardid Ali Hassen (standing) and his baby brother Umer Keyir Ali Hassen, one years old, have been vaccinatied by clinical nurse Ermias Amare (right), during the Polio NIDs campaign in Somali Region, 9 February 2015. THe half-tick mark on the hut's opening flap indicates that not all the children who live their under the age of five have been vaccinated.Sophia's eldest daughter (five years old) is out wtending the families goats, and the vaccination team makes an appointment to return the next day to vaccinate her as well. ©UNICEF Ethiopia/2015/Getachew
Salah Kedir, clinical nurse (left), fills out vaccination records outside the hut of Sophia Abdi in Dudejirma sub-district, Rer Hassen Settlement,Tulugulid District, Fafan Zone. Three year old Sehardid Ali Hassen (standing) and his baby brother Umer Keyir Ali Hassen, one years old, have been vaccinatied by clinical nurse Ermias Amare (right), during the Polio NIDs campaign in Somali Region ©UNICEF Ethiopia/2015/Getachew

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.

Social Mobilisation  

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.

Town crier in Lafaisa subdistrict, Awbare District, using a megaphone to alert parents that children five years and younger will be receiving polio vaccinations during the Polio NIDs Campaign in Somali Region, 9 February 2015. ©UNICEF Ethiopia/2015/Getachew
Town crier in Lafaisa subdistrict, Awbare District, using a megaphone to alert parents that children five years and younger will be receiving polio vaccinations during the Polio NIDs Campaign in Somali Region, 9 February 2015. ©UNICEF Ethiopia/2015/Getachew

“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.”

Campaign Support

Clinical nurses Ermias Amare (front) and Salah Kedir, traveling on motorcycle between pastoral settlements in Tulugulid District, Fafan Zone, Somali Region, to provide polio vaccinations for children five years and younger during the Polio NIDs Campaign, 9 February 2015 ©UNICEF Ethiopia/2015/Getachew
Clinical nurses Ermias Amare (front) and Salah Kedir, traveling on motorcycle between pastoral settlements in Tulugulid District, Fafan Zone, Somali Region, to provide polio vaccinations for children five years and younger during the Polio NIDs Campaign, 9 February 2015 ©UNICEF Ethiopia/2015/Getachew

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.

Sustaining Achievements in Polio Eradication in Ethiopia and Africa

High level Vaccination Session During the Financing for Development conference
PDG Dr Tadesse Alemu, President of Rotary National Polio Plus Committee, World Health Organisation (WHO) Director General Dr Margaret Chan, UNAIDS Executive Director Mr Michel Sidibe, UNICEF Deputy Executive Director Ms Yoka Brandt and Ethiopian Minister of Health Dr Kesetebirhan Admasu poses for a group picture after vaccinating a group of children at Selam Health Centre, Addis Ababa, Ethiopia. Sustaining the Achievements in Polio Eradication in Ethiopia: High level Vaccination Session During the Financing for Development conference ©UNICEF Ethiopia/2015/Westerbeek

Addis Ababa | 14 July 2015. Ethiopian Minister of Health Dr Kesetebirhan Admasu, World Health Organisation (WHO) Director General Dr Margaret Chan, The Global Alliance for Vaccines and Immunisation (GAVI) Chief Executive Officer Dr Seth Berkley and UNICEF Deputy Executive Director Ms Yoka Brandt participated in a high level polio vaccination event at Selam Health Centre in Addis Ababa. Also present at the event were UNAIDS Executive Director Mr Michel Sidibe, US Ambassador Ms Patricia M. Haslach, Brazil Ambassador Mrs Isabel Cristina, President and CEO of PATH Dr Davis Steve, and Rotary National Polio Plus Committee Chairperson PDG Dr Tadesse Alemu as well as national and international EPI partners, health workers and mothers with their children. “Strong leadership, political will and coordination are key to sustaining the gains made in interrupting polio transmission in Ethiopia and Africa,” said Dr Margaret Chan, commending Ethiopia’s aggressive response to the 2013 outbreak of wild polio virus. “Horn of Africa countries should continue to immunise all at risk age groups until the threat drops to zero and eradication is achieved. And this is possible only through high quality immunisation activities for all communities.” When the wild polio virus outbreak in the Horn of Africa spread to Ethiopia in August 2013, the Government of Ethiopia intensified vigilance, surveillance and mass immunisation campaigns, together with partners like WHO, UNICEF, USAID, the US Centres for Disease Control and Prevention (CDC) and Rotary International. Fifteen supplementary immunisation campaigns were implemented with a focus on high risk areas. Cross-border coordination was heightened, with Horn of Africa countries coming together to implement synchronised response activities. It has been 18 months since the last case of wild polio virus was reported in Ethiopia, and 11 months since the last case in Africa. Dr Kesetebirhan Admasu said, “We will focus on equity and quality for every child and mother in Ethiopia,” adding, “The Government of Ethiopia continues to be committed to eradicating polio from Ethiopia, and Africa.” He further affirmed that “The Government of Ethiopia will continue to engage communities for active participation in routine immunisation, and will continue to build strong health partnerships.” With a view of sustaining the achievements in interruption of wild polio virus transmission, and strengthening the immunisation system, the Ministry of Health of Ethiopia, with support from partners, is currently implementing a two-year Routine Immunisation Improvement Plan 2014-2015. The plan pays special attention to low performing prioritised zones and accelerating efforts to support such vulnerable zones to improve performance, among other priority initiatives.

Sustaining the Achievements in Polio Eradication in Ethiopia
Ms Yoka Brandt, Deputy Executive Director, UNICEF gives an anti polio drop to a child at Selam Health Centre. ©UNICEF Ethiopia/2015/Ayene

Ms. Yoka Brandt, asserted, “Immunisation, especially routine immunisation, is a core priority within UNICEF, and it will continue to be. With the availability of new innovations, new vaccines, and new research and evidence, we can go fast and far.” Immunisation is among the most cost effective interventions we can provide to our children. Yet, one in five children are not fully immunised worldwide. In Ethiopia and Africa, children in remote and marginalised communities are more likely to be missed. It is these same children that carry the highest risk of diseases that vaccines can prevent. Therefore we must refine our strategies to reach these children and include them in our services. Reaching every community is an approach that strives at inclusion of all communities, especially the marginalised children, ensuring resources and services are available and monitoring is in place. Dr Seth Berkley, highlighting GAVI’s commitment to strengthening routine immunisation, said, “Strong routine immunisation systems are a bedrock of healthy societies and are central to global plans for the eradication of polio. By working together, we are reaching more children than ever before with lifesaving vaccines and the GAVI partners are committed to supporting countries like Ethiopia to sustain and build on their progress on immunisation.” WHO, UNICEF, GAVI and other immunisation partners remain committed to support African governments in reaching every community with vaccination – the gift of life. Untitled