Muneera Abdo is one of thousands of vaccinators across Yemen working tirelessly to reach every last child with polio vaccine

22 June 2021 – In Al-Buraika district, a poor neighbourhood in the port city of Aden in Yemen’s south, Muneera Abdo slowly makes her way through the sandy streets. With a scuffed plastic cool box hanging from a strap on her shoulder, Muneera knocks on the doors of houses often made of little more than discarded strips of tin.

Muneera is a polio vaccinator working in some of the most challenging territory on earth. She travels door to door, vaccinating children under 5 and raising awareness about the importance of vaccination among parents, many of whom are hesitant about vaccines or refuse outright to vaccinate their children.

“My happiest moment is when I serve my community and contribute to saving the lives of children,” said Muneera.

Muneera is one of thousands of vaccinators across Yemen. Their job is simple, yet overwhelmingly tough: reach every last child with polio vaccine, as many times as it takes to stamp out the virus. Vaccinators travel vast distances across deserts and over hills and mountains to reach communities living far from population centres.

Muneera’s job has never been so important. After more than 15 years without a case of polio, an outbreak of vaccine-derived poliovirus was confirmed in Yemen in 2020. Since then, millions of children have received oral polio vaccine on multiple mass immunization days, to boost immunity and stop the outbreak.

Tayseer Ahmed went door-to-door in Thula district, in the steep, long mountains of Amran governorate in the country’s north during the November 2020 and May 2021 campaigns.

“It’s a daunting job,” said Tayseer, “but tiredness fades away whenever I see parents bringing their children to be vaccinated without any hesitancy.”

Sometimes, vaccinators in Yemen reach the end of a long and difficult road, only to continue on foot for hours more

Conflict delays polio campaigns

Without vaccinators like Muneera and Tayseer, Yemen’s damaged health system and the poor sanitation in many villages could see the poliovirus easily spread from child to child across the country. The conflict and instability that have plunged parts of the country into a prolonged humanitarian crisis have lowered vaccination rates and delayed campaigns, leaving more children vulnerable to the virus.

As of 20 June 2021, a total of 34 children have been paralysed in the outbreak. This grim toll highlights both Yemen’s immunity gap and the challenges of delivering health care in a conflict. Immunization rates in Sa’adah governorate – the epicentre of the outbreak – have declined in the past 16 years since the last house-to-house campaign was conducted in 2004.

Responding to the urgent need to deliver vaccination services to all children in this governorate, WHO and UNICEF, in cooperation with the Ministry of Public Health and Population, have conducted health outreach activities there, targeting around 200 000 children under 5 with polio and other vaccines, and offering other health and nutritional support. Additional rounds of outreach will continue over the course of 2021.

The uptake of services has been informative: the main draw for families was the bundle of health services under the heading “Integrated Management of Childhood Illnesses” (IMCI), which supports children under 5 with health care, including vaccinations. In the first round of outreach, trained health workers provided IMCI treatment to 44 624 children under 5. Of these children, 4967 were under 2 months of age and were vaccinated for the first time.

But in order for these efforts to close Yemen’s immunity gap, they need to be sustained – no easy feat.

“Despite all security and humanitarian challenges, we’ve succeeded in conducting several rounds of vaccination campaigns across the country, reaching millions of children with polio vaccine. However, there's still so much work to be done to contain the current outbreak from spreading further,” said Dr Adham Abdel-Moneim, WHO Representative in Yemen.

As vaccinators like Muneera and Tayseer know, that work can only be done step by step, door to door, child by child. It is an immensely tough job – logistically challenging, but also physically and emotionally gruelling. For this reason, the people at the ground level of polio eradication often view their work not as a job, but as a calling.

“For me, protecting children against diseases is more humanitarian work than a paid job,” said Muneera.

A smiling child's left pinky is marked after he received bivalent oral polio vaccine in Banadir, Somalia, during the outbreak response vaccination campaign. The closure of the cVDPV3 outbreak is a win for public health in Somalia.

29 March 2021 – Somalia’s outbreak of circulating vaccine-derived poliovirus type 3 (cVDPV3) has been successfully stopped, with no international spread. Dr Hamid Jafari, Director of Polio Eradication for WHO’s Eastern Mediterranean Region, declared the outbreak closed a full 28 months after this strain of polio was last detected in Somalia. 

Seven children were paralysed by the type 3 strain in the 2018 outbreak, and sewage samples regularly monitored for poliovirus tested positive for cVDPV3 a dozen times, beginning March 2018. There is no doubt that the virus circulated widely around southern and central Somalia. Despite extensive disease surveillance measures, no cVDPV3 has been identified since 7 September 2018, when the last child developed paralysis. 

Closing a polio outbreak is a formal process steered by a detailed checklist of surveillance indicators that must be met in order to show that the virus is not just hiding in a far-flung pocket but has truly disappeared. Sewage runoff is tested for virus, and health workers and community members actively search for paralysis in children, and then investigate any paralysis they do find to rule out polio. Accessing hard-to-reach communities is a challenge in Somalia, but a vital aspect of this work. 

There is little doubt that the year 2020 will go down in history as one of transformation. No life was left untouched by the COVID-19 pandemic, which disrupted everything from international travel and trade to health systems. But it has not deterred the effort to eradicate polio.

The Eastern Mediterranean regional polio programme reflects on 2020 as a year of immense challenge and innovation. Over the last 12 months, teams have pivoted to provide vital support to countries responding to COVID-19 while maintaining poliovirus surveillance and have worked diligently to resume polio vaccination campaigns and respond to new outbreak emergences.

Whilst the difficulties are far from over, 2020 has shown the resilience of the polio eradication workforce all over the Region, and the determination of parents and stakeholders to achieve a polio-free future.

Since campaigns resumed in July, almost 66 million children in the Eastern Mediterranean Region have received at least one dose of polio vaccine through supplementary immunization activities.

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©WHO/Pakistan

In March, as borders began closing all over the world, the polio programme began an incredible pivot. In every country where the programme works, polio workers adapted their skills to trace contacts, deliver COVID-19 tests and share information on the virus. Meanwhile, polio campaigns were temporarily paused to reduce the risk of COVID-19 transmission. Read about our work to fight COVID-19.

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©WHO/Pakistan

In Pakistan, the Sehat Tahaffuz 1166 polio eradication helpline at the National Emergency Operations Centre (NEOC) for Polio Eradication in Islamabad was transformed to handle COVID-19 enquires too. Call centre staff and medical personnel answered questions from members of the public and shared accurate information on preventing spread of the disease.

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©WHO Afghanistan/Roya Haidari

In Afghanistan, women like Nasrin set forth to continue their work to educate communities about polio, even amid the pandemic. Disease surveillance also continued through 2020, with teams working to mitigate the effects of laboratory closures and national restrictions on movement.

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©WHO Yemen

In July, polio campaigns resumed with strict COVID-19 safety measures in place. Both the Afghanistan and Pakistan polio programmes launched campaigns to urgently provide vaccines to vulnerable children. The early months of the pandemic caused a perilous drop in immunity to many vaccine-preventable diseases, including polio, with an estimated 80 million missed vaccination opportunities. New polio outbreaks were confirmed in Yemen and Sudan in August, both caused by increasing low immunity to poliovirus.

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©WHO Somalia/Ismail Taxta/Ildoog

In Somalia, the first integrated campaign for polio and measles since the beginning of the pandemic went ahead in September. At a global level, an emergency call to action was launched in October to urgently raise money to avert major polio and measles outbreaks.

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©WHO / Lebanon

In Lebanon, WHO supported the Ministry of Health to conduct a joint measles and polio vaccination campaign in an effort to restore pre-pandemic immunization rates. Pandemic-related disruptions to the vaccination programme led to an almost halving of child immunization rates – to 47%. On World Polio Day on 24 October, the Region came together to recognize the immense contributions of health workers, to reflect on the success of a wild polio-free Africa, and to acknowledge the work ahead to boost immunity levels and fight outbreaks in the Eastern Mediterranean Region.

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©WHO Sudan / Mohamad Dawod Mohamed

November and December saw vaccination campaigns in countries including Sudan, Djibouti and Iraq. The Eastern Mediterranean is now the only wild poliovirus endemic region in the world, and 2019 and 2020 have seen the virus spread in Afghanistan and Pakistan. It is crucial that progress is made in 2021 to protect the gains that have got us 99.9% of the way to a polio-free world.

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©WHO Somalia / Siyaad Mohamed / Ildoog

In countries around the Region, the polio programme stepped up for the pandemic emergency response, training thousands of personnel to adhere to COVID-19 precautions while delivering essential immunization and other health interventions. Despite the challenges that 2020 has held, the immense work achieved in the last 12 months has left us with even greater confidence that we can end polio.

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