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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When we last convened, it was a very different world. The COVID-19 pandemic was hitting its early stride, and the polio programme in our Region had just stepped forward bravely to meet this new public health challenge, working alongside national health programmes and, in countries with limited or weakened health infrastructure, stepping into the breach.

In the intervening months, I observed as the polio programme in some of the most complex countries in this Region – Pakistan, Afghanistan, and others – paused their polio eradication activities and applied their considerable skills to the COVID-19 pandemic.

1243 staff were engaged in COVID-19 response. Polio’s contact tracing systems, surveillance networks and workforce were rapidly deployed in a chaotic, fast-changing operating environment to identify COVID-19 cases, their contacts, surveil for symptoms and roll out waves of testing and health education. What was apparent to me in the mid-year months was that the investments we have made in polio eradication are actually investments in broader public health infrastructure and pandemic response. 

Unfortunately, COVID-19 exacted a heavy toll on the polio programme. More than 200 of our polio personnel have been infected since the start of the pandemic, and three of them lost their lives due to COVID-19.

The pandemic cost us the opportunity to vaccinate 50 million children. Meanwhile both wild and vaccine-derived polioviruses spread unchecked. In July, polio vaccination campaigns re-started, with vaccinators equipped with PPE and using no- and low-contact techniques. We have successfully carried out large-scale campaigns in Pakistan, Afghanistan, Syria and parts of Yemen since the restart. Polio workers across the region are to be commended for the speed at which they trained on new COVID-era techniques and behaviours, and their successful and ongoing resumption of campaigns.

We celebrated the certification of African Region as free of wild poliovirus and are redoubling our own efforts as the last remaining polio endemic Region. Now is the time to be shoring up the polio programme and mobilizing funding, including domestic funds, so that this remarkable public health and pandemic response mechanism can remain robust and can be integrated into broader public health services across the region. Now is the time for full regional solidarity and mobilization.

I am pleased to report that the Regional Committee reaffirmed its commitment in a resolution to complete wild poliovirus eradication and polio transition. The Member States resolved to stop all cVDPV outbreaks and prepare for the introduction of the novel OPV type 2. I am also particularly pleased by the commitment of Ministers of Health in our region to bring their own wisdom, influence and authorities in the newly established Regional Sub-Committee for Polio Eradication and Outbreaks. Moreover, I have given polio transition my close attention, establishing and chairing the Regional Steering Committee on Polio Transition. The committee has been working towards adapting our polio transition strategies and coordinating with priority Member States in the evolving context of COVID-19. The contribution of the polio programme to the pandemic has highlighted the added value and feasibility of cross-programmatic integration, with the setting up of integrated public health teams in priority countries in the region. It is very important for us to move ahead in implementing polio transition strategies, to strengthen national immunization programmes and support country readiness for the introduction and equitable distribution of COVID-19 vaccines, as well as strengthen emergency preparedness and response, and health systems.    

Listen to Dr Al-Mandhari’s statement, presented in the fourth meeting of Committee A, Item 11 (Pillar 1)

Delegates listen to Regional Polio Director Dr Hamid Jafari’s presentation on polio eradication in the Eastern Mediterranean Region. Credit: WHO/EMRO

Renewed political commitment drives likely formation of new subcommittee for polio eradication and outbreaks.

14 October 2020 – Yesterday the 67th Regional Committee for the Eastern Mediterranean discussed a resolution on polio, which includes the creation of a new ministerial regional subcommittee to focus on the most critical barriers standing in the way of polio eradication.

Following the certification of the African Region as free of wild poliovirus, the Eastern Mediterranean Region is the only region in the world still harbouring wild poliovirus. After a bruising 2019 where we saw wild poliovirus on the rebound in Afghanistan and Pakistan, 2020 dawned with high hopes that the programme would be able to shift gear and make up for lost ground. The COVID-19 pandemic put the brakes on those plans and added untold layers of complexity to the provision of health care, but it hasn’t destroyed the dream. The new subcommittee, if adopted, will be a strong demonstration of Member States’ political commitment and solidarity towards getting polio eradication back on track.

The risk of international spread of poliovirus remains a public health emergency of international concern. During 2020, the Region has experienced new outbreaks of vaccine-derived poliovirus in Sudan and Yemen, even as the outbreaks in Somalia, Afghanistan and Pakistan continue to paralyse children. The new subcommittee would aim to intensify support to these countries. An immediate priority is advocating for the domestic and international financial resources needed to close outbreaks and eradicate the disease once and for all.

In the next few months, the polio programme plans to roll out a new type 2 oral polio vaccine, specifically designed to tackle vaccine-derived outbreaks. This is likely to have a transformative effect on our abilities to protect children and stop outbreaks spreading further. But the introduction of a new vaccine does not negate the importance of other tactics to fight vaccine-derived polio, including high quality disease surveillance, building community vaccine acceptance and strengthening routine childhood immunization.

The messages the subcommittee would likely convey in its reports to WHO's governing bodies apply to all polioviruses: that routine and supplementary immunization systems must improve across the Region, and every child must receive the vaccines they need. The subcommittee would also work to promote political and social neutrality and facilitate access to all children living in conflict-affected areas.

The subcommittee would be made up of health ministers from interested Member States of the Region, with special invitations extended to representatives from Afghanistan and Pakistan. The group would meet four times a year.

During the Regional Committee meeting, the Governments of Egypt, Islamic Republic of Iran and Pakistan expressed a desire to lead the charge by joining the subcommittee. If the resolution is adopted, WHO will be inviting all ministers of health to express their interest in becoming members.

The Pakistan representative stated, “The Government of Pakistan welcomes and supports the establishment of a subcommittee of polio eradication. Dr Faisal Sultan, the Special Assistant to the Prime Minister on Health, has expressed his willingness to take part in the subcommittee, which will undoubtably provide an ideal platform to strengthen regional cooperation and support Afghanistan and Pakistan in successfully eradicating poliovirus across the shared epidemiological block.”

Dr Hamid Jafari, WHO Regional Director for Polio Eradication, thanked Member States for offering their support for the creation of the subcommittee, and the entire resolution, saying, “This is a crucial step forward to regain ground lost against the poliovirus in the last two years. Strong political commitment to the polio eradication goal is paramount for us to defeat this disease”.

In the run up to World Polio Day on 24 October, the adoption of the resolution would be a meaningful step forward towards achieving a polio-free future for all children in the Eastern Mediterranean Region. The WHO continues to emphasize the importance of high-quality immunization for every child, and advocates for access to every community in order to reach all children with vital health services.