Regional experts confirm the polio outbreak is successfully interrupted in Ethiopia and Kenya

Vigilance in Somalia and region still needed before the region is declared polio-free once more.

By Shalini Rozario

Dr. Jean-Marc Olive, Horn of Africa (HOA) Polio Technical Advisory Group (TAG) Chair, chairs proceedings of the HOA Polio Outbreak Final Assessment
Dr. Jean-Marc Olive, Horn of Africa (HOA) Polio Technical Advisory Group (TAG) Chair, chairs proceedings of the HOA Polio Outbreak Final Assessment, and is seated with representatives from the Kenyan Government, WHO, UNICEF and partners such as Rotary International, The Gates Foundation, CDC among others. ©UNICEF Ethiopia/2015/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.

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Polio transmission deemed interrupted in Ethiopia

Polio transmission deemed interrupted in Ethiopia by 4th polio external assessment; final decision awaited by Horn of Africa Final Assessment on 17 June.

Assessment recommendations include sustaining polio achievements for “polio legacy” in Ethiopia.

By Shalini Rozario 

12 June 2015

Health Extension Worker administers Polio Vaccination
National Polio Vaccination Campaign. ©UNICEF Ethiopia/2005/Heger

Addis Ababa. From 8-12 June 2015, the 4th Polio External Assessment took place in Addis Ababa, to review the progress to date of the polio outbreak response, and determine the quality and status of the outbreak in the country. The assessment team was led by WHO and included members from CDC, Core Group, the Gates Foundation, UNICEF and others. The assessment team looked in detail at key elements of the polio programme including surveillance, campaign quality, communication, vaccine supply and logistics and other factors contributing to the interruption of the polio virus transmission.

4th external polio assessment debriefing
His Excellency Dr. Kebede Worku, State Minister to the Federal Ministry of Health of Ethiopia along with Dr. Pierre Mpele-Kilebou, WHO Representative to Ethiopia; and Gillian Mellsop, Country Representative to UNICEF Ethiopia during the 4th external polio assessment debriefing on 12 June 2015. ©UNICEF Ethiopia/2015/Rozario

On Friday afternoon, 12 June, the external assessment team debriefed His Excellency Dr. Kebede Worku, State Minister to the Federal Ministry of Health of Ethiopia along with Dr. Pierre Mpele-Kilebou, WHO Representative to Ethiopia; Gillian Mellsop, Country Representative to UNICEF Ethiopia along with key polio partners, and reviewed findings of the week-long assessment.

The overall conclusion was that the assessment believes that transmission in Ethiopia has been interrupted and called for sustained government support to ensure sustained gains.

Since the onset of the Horn of Africa (HOA) polio outbreak in May 2013, Ethiopia responded intensively. Following confirmation of cases in Somalia and Kenya, the first confirmed WPV case in Ethiopia was in August 2013 in the Somali Region resulting in a total of 10 WPV type-1 (wild poliovirus type 1) cases in the Doolo Zone of Somali Region. The last WPV case was confirmed in January 2014 — nearly 17 months ago – an indicator of interruption of transmission due to the intensive vaccination response, which includes 14 vaccination campaigns reaching children in all corners of the country with OPV (oral polio vaccine), including 4 rounds of National Immunization Days (NIDs), targeting between 12 to over 14 million children. All campaigns were supported with intensified communication and social mobilization activities, and engaged partnerships for solid community awareness, knowledge and acceptance of OPV.

H.E. Dr. Kebede responded enthusiastically to the assessment outcome, and stated, “The outbreak was closed due to the frontline teams and practioners on the ground.” He expressed support and said to value the recommendations to strengthen routine immunization, surveillance and quality SIAs (campaigns), which will benefit children and the health system in general. H.E. Dr. Kebede expressed gratitude to the leadership of the regional governments, particularly in the Somali Region. He appreciated efforts of community leaders, including religious leaders of the Islamic Affairs Supreme Council, who played a key role in the outbreak response. Dr. Kebede thanked Dr. Pierre Mpele-Kilebou, for his commitment, and for his frequent visits to the outbreak epicenter, Doolo Zone of the Somali Region. He also welcomed Gillian Mellsop, as the new Country Representative to UNICEF Ethiopia and appreciated both partners for their contributions along with the other Polio Eradication Initiative partners such as CDC, Core Group, the Gates Foundation and Rotary International.

4th external polio assessment debriefing
Dr. Pierre Mpele-Kilebou, WHO Representative to Ethiopia; Gillian Mellsop, Country Representative to UNICEF Ethiopia and Macoura Oulare, Chief of Health, UNICEF Ethiopia catch up during the 4th external polio assessment debriefing on 12 June 2015. ©UNICEF Ethiopia/2015/Rozario

Dr. Pierre Mpele-Kilebou and Gillian Mellsop, congratulated the Ministry of Health on their achievements, expressed their support for the polio programme, and acknowledged the importance of drawing on the successes and lessons learned for the “polio legacy” in Ethiopia.

Final recommendations will be delivered to the Horn of Africa countries, government representatives and partners on 17 June 2015 in Nairobi at the Horn of Africa Outbreak Final Assessment Debriefing.

World Polio Day 2014 commemorated in Ethiopia

By Shalini Rozario

On 24 October 2014, UNICEF, WHO, Rotary International and Federal Ministry of Health (FMOH) gathered to commemorate World Polio Day, which also coincided with United Nations Day. In a Joint Statement issued by WHO, UNICEF and Rotary, the partners appreciated frontline workers in the fight against polio and called for sustained support for eradication efforts.

World Polio Day celebrated in Addis Ababa Ethiopia in the premises of the UNECA compound.
World Polio Day celebrated in Addis Ababa Ethiopia ©UNICEF Ethiopia/2014/Ayene

The World Polio day commemoration commenced with a moment of silence for the late Past District Governor (PDG) Nahu Senaye Araya, President of the Rotary National Polio Plus Committee. Ato Araya’s family, in attendance, was presented with a certificate of appreciation by WHO, UNICEF and Rotary for his years of dedicated service to the polio programme.

Dr. Pierre Mpele-Kilebou, WHO Representative to Ethiopia, stated in his welcoming remarks, “Today is a reminder of our duty to make sure that no more children are paralyzed by the disease that can be prevented with a simple, easy to administer vaccine.” The screening of two short videos, Help #EndPolio Forever and Curbing the polio spread through nation wide immunisation campaign, followed his welcoming remarks.

Patrizia DiGiovanni, Acting Representative to UNICEF Ethiopia commended the contribution of partners in her key note address and emphasized the gains being made to reach all children with the polio vaccine and improved child survival interventions. “As the World Polio Day coincides with UN Day, we place our efforts within the broader context, as we work to uphold a child’s right to health as a basic human right for all. With the deadline fast approaching for measuring progress against achievement of the MDGs, our minds turn to the Ethiopia’s remarkable achievement of reaching MDG4. I believe, if we had the ability to achieve this goal three years ahead of schedule, we can certainly work together to ensure all eligible children are fully immunized by their first birthday.”

PDG Tadesse Alemu speaks at the World Polio Day
PDG Tadesse Alemu speaks at the World Polio Day commoration in Addis Ababa, Ethiopia ©UNICEF Ethiopia/2014/Ayene

On a keynote address by PDG Dr. Tadesse Alemu, who recalled the commitment and dedication of PDG Nahu Senaye Araya, said “Swift and unprecedented changes in the world has impacted efforts of polio eradication. We must have strong push to end polio now. Dr. Taye Tolera, Special Advisor to the State Minister of Health, Federal Democratic Republic of Ethiopia, delivered remarks from the Ministry of Health. He stated, “This joint commemoration clearly shows that all partners and allies have maintained the stamina in the commitment and support to the Expanded Programme on Immunization and the Polio Eradication Initiative.” He called for continued commitment: “We all should be proud of our shared achievements. But, we should continue the journey until this highly interconnected world we all share is free of polio before 2018.”

As part of the World Polio Day events, Rotary International announced earlier in the week a US$44.7 million grant to fight polio in Africa, Asia and the Middle East on 21st October this year with Ethiopia to receive US$ 2 million for polio eradication efforts in the country.

Read the press release by UNICEF here.

World Health Organization, UNICEF and Rotary International, appreciate frontline workers in the fight against polio and call for sustained support for eradication efforts.

World Polio Day 2014 banner
Addis Ababa, 24 October 2014 – The World Health Organization, UNICEF and Rotary International stand together in the fight against polio and in commemoration of World Polio Day, 24 October 2014.

Despite significant progress made in polio eradication since the launch of the initiative in 1988, the wild poliovirus (WPV) continues to infect people, causing life-long paralysis and disability. The Horn of Africa was struck with a polio outbreak in April 2013. To date, 223 cases of WPV1 have been confirmed in Somalia, Kenya and Ethiopia. The date of onset of the last case confirmed in Somalia was in August 2014.

Up until 2013, Ethiopia was polio-free since 2008. However, since last year, Ethiopia has confirmed 10 cases of polio in Doolo Zone, Somali Region. Ethiopia’s response to this crisis has been fast and aggressive. Since June 2013, 11 rounds of polio immunization campaigns have been conducted in addition to ongoing border vaccination at 45 permanent vaccination posts along the border with Somalia. National immunization days (NIDs) in October and December 2013 reached over 12 million and 15 million children, respectively. Due to these aggressive efforts, the last case of WPV in Ethiopia was confirmed more than 9 months ago, in January 2014.

The success of these polio immunization efforts is a result of national commitment and the coordinated efforts of immunization partners. We recognize those who are in the forefront of the fight against this debilitating disease: health workers, vaccination teams, mobilizers, traditional and religious leaders, partners and others who work long hours, and walk long distances, to ensure all children are reached with the polio vaccine.

Rotary International launched a new campaign that promises every dollar donated to Rotary will be matched 2-to-1 by the Bill & Melinda Gates Foundation. On 21 October 2014, Rotary International announced the release of US$ 2 million to support polio eradication efforts in Ethiopia. UNICEF supports communication and social mobilization, vaccine procurement, cold chain and logistics and technical assistance while WHO is providing technical assistance, coordination support, including across cross border coordination, and surveillance support.

As World Polio Day is commemorated on the same day as UN Day today, we remember our efforts within the broader context, a day when we uphold a child’s right to health as a basic human right for all. As we look to 2015, we measure the success of our efforts against achievement of the Millennium Development Goals, acknowledging the contribution of polio immunization efforts to MDG achievement. In two weeks, Ethiopia will conduct the first of two rounds of the 2014 NIDs aiming to vaccinate over 13 million children. We look to all partners, decision makers, donors, leaders and other stakeholders to provide their support so that we can ensure no child is left behind. We will continue to work together to END POLIO NOW.

 

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For further information, please contact:

Mohammed Idris, Rotary International, +251911197755, mohammedsany@gmail.com

Wossen Mulatu, UNICEF, +251 11 518 4028, wmulatu@unicef.org

Fiona Braka, WHO, +251 11 553 4777, brakaf@who.int

Ten million childhood disabilities prevented in campaign to end polio – UNICEF

ADDIS ABABA/NEW YORK, 23 October – Every day, a thousand or so children have been protected from disability during a 26-year global effort to eradicate polio.  The worldwide campaign has immunised millions of previously-unreached children across the globe, UNICEF said on the eve of World Polio Day.

A child gets a mark after polio vaccination
Ayan Hassan marks a child after polio vaccination. Warder, Somali region, Ethiopia. ©UNICEF Ethiopia/2013/Sewunet

Some 10 million people today would otherwise have been paralysed, while an additional 1.5 million lives have been saved through the routine administration of Vitamin A during polio vaccination drives.

The annual number of polio cases has fallen from 350,000 in 1988, to 416 in 2013, and 243 so far this year – an extraordinary drop of more than 99 percentAll but three countries where polio was firmly entrenched – Afghanistan, Nigeria and Pakistan – have eliminated the virus within their borders. And multiple outbreaks have been contained over the past 26 years.

“In 1988 polio was a leading cause of childhood disability,” said UNICEF Executive Director Anthony Lake. “In country after country since then, a generation of children has grown up without the spectre of polio.”

“The success of the eradication effort – reaching some of the most disadvantaged communities in some of the most dangerous circumstances – proves that it is possible to reach all children,” Lake added. “Our most ambitious and audacious goals for children can be met. And if they can be, they must be.”

In Ethiopia, despite significant progress made in polio eradication since the launch of the initiative in 1988, the wild poliovirus (WPV) continues to infect people, causing life-long paralysis and disability, which can only be prevented through vaccination. The Horn of Africa was struck with a polio outbreak in April 2013. To date, 223 cases of WPV1 have been confirmed in Somalia, Kenya and Ethiopia to date. The date of onset of the last case confirmed in Somalia was in August 2014, indicating ongoing circulation of WPV in the region. Up until 2013, Ethiopia was polio-free since 2008. However, since last year, Ethiopia has confirmed 10 cases of polio – a tragic setback for the country and for the families and children affected.

Legs of Ayan Yasin Confirmed Wild Polio Virus (WPV-1) case in Degafur rural village
Legs of Ayan Yasin Confirmed Wild Polio Virus (WPV-1) case in Degafur rural village, Somali region of Ethiopia ©UNICEF Ethiopia/2013/Sewunet

 Rotary International, a lead in the global polio eradication initiative, has contributed more than US$1.3 billion to eradication efforts globally to date. A new campaign promises that every dollar donated to Rotary will be matched 2-to-1 by the Bill & Melinda Gates Foundation. Rotary has announced a US$44.7 million grant to fight polio in Africa, Asia and the Middle East on 21st October this year and Ethiopia will receive US$ 2 million for polio eradication efforts in the country.

”Rotary International’s commitment to polio eradication has been instrumental in the swift and robust outbreak response in Ethiopia,” said Patrizia DiGiovanni, Acting Representative, UNICEF Ethiopia. “As partners in the fight against polio, we remain resolved to ensure no child is left unimmunized. Every child deserves the basic human right to health and we thank Rotary for their unwavering commitment in this endeavour.”

Nigeria has had only 6 cases this year, down from 49 in 2013. Afghanistan has reduced transmission to very low levels, with most cases linked to Pakistan.  With 206 cases already reported this year, Pakistan is now the world’s largest remaining reservoir of polio.

While polio remains endemic in only three countries, it continues to pose a risk to children everywhere, especially in countries which have not made routine immunization a priority, like South Sudan, the Central African Republic and Ukraine. Outbreaks in Syria, Iraq, Cameroon, Equatorial Guinea and Somalia can be traced to Pakistan and Nigeria.  

UNICEF procures 1.7 billion doses of oral polio vaccine to reach 500 million children every year. And UNICEF’s social mobilisation work helps persuade families to accept the vaccine when it reaches them.  Intensive efforts over the past decade have seen acceptance of the polio vaccine at their highest levels ever in countries where polio remains endemic.

 “The world has never been closer to this once-in-a-generation opportunity of eradicating polio for good,” Lake said. “Every child deserves to live in a polio-free world.”