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Nomina Akhtar continues to work for polio eradication while battling stage-3 breast cancer
A story of determination, friendship and support
19 August 2022 – In 2021, when the news of cancer hit, Nomina Akhtar felt her world collapsing. It was discovered too late. By the time she knew, it was already stage-3 breast cancer.
Since 2015, Akhtar has been part of Pakistan’s polio programme as a community health worker. During these 6 years, she has found friends and well-wishers among her team members who have given her the support to carry on.
Akhtar, 43 and a mother of 3 continues to work for polio eradication as she undergoes treatment for cancer. “I gathered my courage and promised that I will fight till the end and live for my children. All my family, colleagues and seniors were with me whenever I needed support. That gave me courage and made me believe that I could, in fact, beat cancer.”
Based in Peshawar, Nomina’s husband and her 3 children, aged 6, 7 and 18, rely solely on her income. The lockdowns due to the pandemic caused her husband, a motorcycle mechanic, to close down his shop that has yet to reopen.
A life with cancer has been both physically and emotionally exhausting. She is undergoing both radiation and chemotherapy in Peshawar. This means a commute of almost 20 kilometers after a whole day of work.
“When I have to go for chemotherapy after work, it becomes very draining. I have to take public transport and wait at the hospital for hours. There are times when I have to return without treatment because either the machine is faulty or something else comes up. This treatment regime along with the medicine will continue for at least 5 years. It’s excruciatingly painful,” she says.
Polio programme: a great source of strength for Akhtar
“My colleagues are like my extended family, and I am like a sister to them. When I found out about my cancer, they wept with me. They have stood by my children and myself every step of the way.”
The supervisor of her area, Uzma Mansoor, says that when they first heard the news, they were devastated. “But it’s great to see that she has not lost hope and is fighting the disease like a champion,” she said.
The community she works in has also been incredibly supportive. “Some of the people in my work area came to know about my illness and they appreciated the fact that despite fighting cancer, I come to their doorstep during every polio campaign. Irrespective of extreme temperatures and illness, I am there to vaccinate their children and protect them from this life-threatening disease. Their support has increased manifold after this.”
Sahibullah, the Union Council Polio Officer of her area, says not only does Nomina continue to vaccinate children, but she is a role model for all other polio workers.
“It was God’s will, and we will face it with courage,” says her husband Aurangzeb Akhtar. “Despite being ill, Nomina is the one who keeps us going. She is working and earning for our family as well as motivating us to not lose hope. My children and I are so proud of her. Inshallah she will get well very soon.”
Nomina has strong conviction. She is fighting cancer and polio simultaneously, and is determined that she will defeat both very soon. “At least cancer has treatment,” she says. “Polio is incurable and the sooner we end this disease forever, the better.”
Electronic reporting system digitizes reporting for polio certification
36th meeting of the Regional Commission of Certification endorses submission of reports for 2021
14 August 2022 – One of the key markers on the global journey towards eradication of poliovirus is certification, the formal verification of a region as polio-free. Last month, that marker got a digital upgrade.
Following the resolution passed at the World Health Assembly in 1988 to eradicate polio, the Global Certification Commission was established to lead the formal process for certifying regions as polio-free.
In 1995, WHO’s Eastern Mediterranean Region established the Regional Commission of Certification (RCC). The RCC comprises public health and scientific experts who independently review and assess country data and documentation of activities and reports submitted by the national committees on polio eradication for all countries in the Region.
The RCC serves an important purpose: it reviews the annual certification reports submitted by countries in the Region to identify gaps in polio-free countries and recommends appropriate risk mitigation measures. It also works closely with the National Certification Committees (NCCs) and other groups, and reviews progress towards certification of polio eradication and to containment of laboratory stocks of poliovirus.
Each year, the RCC meets with members of the NCC from countries in the Region, stakeholders from the Global Polio Eradication Initiative and ministries of health to review the epidemiological situation, progress and submits recommendations to countries.
In May, the RCC met for its 36th meeting in Dubai. Speaking at the event, WHO Regional Director for the Eastern Mediterranean Dr Al-Mandhari expressed appreciation for the efforts of the RCC to support polio eradication in the Region. “I am pleased to inform you that as a result of your efforts, 20 out of the 22 countries in our Region had achieved the required standards for poliomyelitis certification. With significant gains in the last 2 endemic countries of our Region, we are closer than ever to eradicating polio.”
This year, The RCC had reviewed reports from Bahrain, Djibouti, Egypt, Islamic Republic of Iran, Iraq, Jordan, Kuwait, Libya, Oman, Palestine, Qatar, Saudi Arabia, Somalia, Sudan, Syria, Tunisia, United Arab Emirates and Yemen. The reports had been provisionally accepted pending revision based on RCC comments. For Afghanistan and Pakistan, their progress reports were reviewed and noted by the RCC.
During the meeting, the RCC endorsed the new Electronic Annual Certification Reporting (e-ACR) system, effectively taking the system out of beta status and moving it into established practice and agreed for certification reports to be submitted through this system prior to the 37th RCC meeting in 2023.
The e-ACR, as a recommendation from the RCC during the 33rd meeting in 2019, was developed as a web-based system to mimic the offline workflow, including submission, review, approval and archiving of reported data within the annual certification reports. It allows for customized and structured data entry that will help users to easily retrieve data for comparison and analysis with reports from previous years – a process that previously was reliant on records kept in multiple separate systems, or even paper records.
Following the software development, 65 participants representing the RCC, NCCs and ministry of health focal persons from 13 countries were trained in 2 separate sessions in May and June 2022. Feedback and recommendations from these trainings are being incorporated into the e-ACR system. A third training is scheduled for September 2022 for representatives from the 9 remaining countries in the Region.
The introduction of the innovative e-ACR system makes the Region to be one of the leading among other WHO regions in digital archive of all certification reports. This system not only facilitates easy retrieval of data but also allows for the next generation of disease eradicators to learn from the experience of certification and the process of polio eradication.
Regional Subcommittee on Polio Eradication and Outbreaks holds fifth meeting
Cairo, 14 June 2022 – The fifth meeting of the Regional Subcommittee on Polio Eradication and Outbreaks was convened on 14 June by WHO’s Regional Director for the Eastern Mediterranean, Dr Ahmed Al-Mandhari.
The meeting comes at a time when Afghanistan and Pakistan, as the last two endemic countries in the world, continue their efforts to stop wild poliovirus transmission, – and several countries in the Region are responding to circulation of vaccine-derived polioviruses.
“The continued presence of any circulating poliovirus in any country of the Region has catastrophic consequences for children who are paralyzed, and poses a threat to national, regional and global health security. The need for regional solidarity, collaboration and collective action has never been greater,” said Dr Al-Mandhari.
Polio remains a Public Emergency of International Concern with wild poliovirus (WPV1) continuing to circulate in Pakistan and Afghanistan. In 2022, one case of WPV1 has been reported in Afghanistan and eight cases in Pakistan, all from the North Waziristan district in southern Khyber Pukhtunkhwa province.
Transmission of circulating vaccine-derived poliovirus type 2 (cVDPV2) continues in the Region in 2022. As of June, Djibouti, Egypt, Somalia and Yemen are responding to ongoing cVDPV2 transmission.
During the fifth Subcommittee meeting, Member States issued two statements; the first on the persistence of wild poliovirus in the epidemiological bloc of Afghanistan and Pakistan, and the second on stopping the expanding cVDPV2 outbreak in Yemen, and on the need for Somalia to fully implement the new Somalia Emergency Action Plan, launched at the Somalia Call to Action Meeting for Polio Outbreak Response in March 2022, to stop the longest running cVDPV2 outbreak.
“Pakistan’s Polio Programme continues to work extremely hard to reach zero polio, and the recent cases in Pakistan have made us more determined to fight this virus till the very end. Since the first case appeared, the health ministry and the polio programme have been working very closely together to meet the needs of the hour and effectively interrupt poliovirus transmission,” said H.E. Qadir Patel, Minister of Health, Pakistan.
Emphasizing the importance of reaching all children, co-chair of the Regional Subcommittee, Dr Hanan Al-Kuwari, Minister of Public Health of Qatar, said, “For our Region to be free of polio, we have to get ahead of the virus and strengthen immunity levels in all at-risk children across the Region, particularly those who are inaccessible or persistently missed by routine immunization and polio vaccination campaigns.”
Reflecting on the urgency of stopping poliovirus circulation in the Region, Subcommittee co-Chair and Minister of Health and Prevention of the United Arab Emirates, H.E. Abdul Rahman Mohammed Al Owais, welcomed the decision by Dr Al-Mandhari to place all WHO operations for polio eradication on an emergency footing, using the standard operating procedures for graded emergencies.
“For us to succeed, we need WHO and relevant stakeholders to systematically apply standard operating procedures for graded emergencies to finally stop all polio in the Region,” H.E. Al Owais said.
During the meeting, Dr Al-Mandhari recognized Djibouti and Sudan for their timely and sustained efforts in responding to the detection of circulating vaccine-derived polio virus.
“The support of the Subcommittee is critical for our work to bring an end to polio. I am thankful to Members of the Subcommittee and the leadership of GPEI partners for their continued commitment and solidarity to finally end polio in our Region.” said Dr Hamid Jafari, director of the regional polio programme and co-facilitator of the Regional Subcommittee.
The meeting was attended by health ministers or their representatives from Djibouti, Egypt, Iraq, Pakistan, Qatar, Sudan, Tunisia and United Arab Emirates, along with representatives from the partners of the Global Polio Eradication Initiative and donors.
More information about the Regional Subcommittee and previous meetings can be found here: Regional Subcommittee for Polio Eradication and Outbreaks website
For more information please contact:
Inas Hamam
Communication Officer
WHO Regional Polio Programme
Notes for editors
The Regional Subcommittee was formally endorsed by Member States through a resolution at the 67th session of the Regional Committee for the Eastern Mediterranean in October 2020. The first meeting was held in March 2021.
The Subcommittee focuses on four strategic areas of focus to engage in coordinated action and support of regional polio eradication efforts including pushing for collective public health action, strengthening efforts to transition polio assets and infrastructure, advocating for the mobilization of national and international funding to sustain polio eradication efforts.
Statement on stopping wild poliovirus transmission in Afghanistan and Pakistan
Statement by the Eastern Mediterranean Ministerial Regional Subcommittee on Polio Eradication and Outbreaks
Fifth Meeting of the Regional Subcommittee on Polio Eradication and Outbreaks
14 June 2022
Noting the progress achieved globally in eradicating wild poliovirus transmission since 1988, with virus transmission restricted to just two countries – Afghanistan and Pakistan;
Noting that one case has been reported in Afghanistan and eight in Pakistan since January 2022, and that detection of wild poliovirus cases in both countries so far has been contained within the southern corridor comprising the southeastern part of Afghanistan and southern districts of Khyber Pukhtunkhwa province in Pakistan;
Noting that Pakistan completed 15 months without reporting a case of wild poliovirus – the longest period that the country has reported no human cases;
Underscoring that the recent isolation of wild poliovirus from environmental samples in Pakistan and children in Afghanistan confirms continued poliovirus circulation in this joint epidemiological block;
Noting that the populations in this epidemiological bloc remain at high risk from polio due to low rates of routine immunization and supplementary polio vaccinations;
Underscoring the critical need for continued cross-border collaboration to reach children with polio vaccines, and for enhanced polio surveillance to detect the virus;
Noting the timely actions taken by the Prime Minister and Health Minister of Pakistan to respond to the current outbreak of cases in North Waziristan;
Highlighting the sustained commitment by leaders at all levels, notably by political leaders, community and religious leaders, civil society, Global Polio Eradication Initiative partners, especially Rotary International and individual Rotarians and health workers at the forefront in responding to the virus;
Recalling that the spread of poliovirus constitutes a Public Health Emergency of International Concern under the International Health Regulations (2005);
Appreciating and supporting the decision of the WHO Regional Director for the Easter Mediterranean to formally grade all polio emergencies and apply relevant emergency standard operating procedures to WHO operations to address polio emergencies;
We, the Eastern Mediterranean Regional Subcommittee on Polio Eradication and Outbreaks:
DECLARE:
1. The ongoing circulation of wild poliovirus in Afghanistan and Pakistan to be a Regional Public Health Emergency;
COMMIT TO:
2. Mobilizing all necessary engagement and support, by all political, community and civil society leaders and sectors at all levels, needed to fully resolve the Regional Polio Public Health Emergency;
3. Supporting the coordination of activities across borders to ensure synchronized and cross-border response activities between Afghanistan and Pakistan; and
REQUEST:
4. The international donor and development community to continue supporting the national polio programmes to facilitate implementation of national emergency action plans to end polio in Afghanistan and Pakistan;
5. Sustained and strengthened commitment from all leaders at all levels in Afghanistan and Pakistan, to capitalize on the current epidemiological window of opportunity through intensified eradication efforts, including by continuing to increase access to all children in previously inaccessible areas, implementing area-specific emergency action plans in known underperforming areas and responding to the detection of any new viruses from any source, acute flaccid paralysis case or environmental samples as an emergency;
6. Effective operational delivery by the polio programme to ensure administration of vaccine to the youngest and most vulnerable children who are persistently missed during routine immunization and polio vaccination campaigns, to seize the opportunity to build immunity levels and stop polio transmission;
7. The Regional Director to continue his tremendous leadership and support to Afghanistan and Pakistan in their efforts to eradicate polio, including by advocating for all necessary financial and technical support, coordinating WHO efforts with the wider regional GPEI partnership through the Polio Hub in Amman, reviewing progress, planning corrective actions as necessary, and regularly informing Member States of the aforementioned and of any eventual further action required, through the World Health Organization Executive Board, World Health Assembly and Regional Committee.
