Polio Elimination in Africa: a Harbinger for Success

Polio Elimination in Africa: a Harbinger for Success

26.8.2020
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Photo: Louie Rosencrans/CDC - A child in the arms of her mother receiving her dose of the oral polio vaccine. Cameroon, 2015.

This week we celebrate a critical step on the path to eradication of polio. After decades of progress, Africa has accomplished the elimination of wildtype poliovirus from its many shores, reflecting enormous effort across 47 countries and liberating the continent from the threat of a disease that paralyzed 75,000 children each year only 25 years ago.

Africa has accomplished the elimination of wildtype poliovirus, reflecting enormous effort across 47 countries and liberating the continent from the threat of a disease that paralyzed 75,000 children each year only 25 years ago

This milestone is a tribute to all involved: from the staff who delivered vaccines, sometimes at great risk to themselves, to the communities that welcomed vaccination, local and traditional leaders that backed the safety of polio prevention campaigns, and leadership at the highest political level in each country, who have had to support the global initiative even when disease rates were so low it was no longer a national priority. To be successful, each country has had to implement and sustain high immunization levels, sometimes in the context of skepticism and active resistance, build new surveillance systems to monitor for the virus in the environment, and make sure that every case of paralysis was identified and monitored.

This is excellence in global health and a great lesson on the ability of this continent to tackle the myriad health problems it faces, from other infectious diseases like malaria, tuberculosis and COVID-19, to an emerging chronic disease agenda. Optimism is a key ingredient of success and pausing, this week, to recognize this achievement is a welcome respite from the concerns about the current pandemic.

This is excellence in global health and a great lesson on the ability of this continent to tackle the myriad health problems it faces, from other infectious diseases like malaria, tuberculosis and COVID-19, to an emerging chronic disease agenda

Sustaining the polio programme –vaccination and surveillance– is absolutely critical. Surveillance quickly identifies re-importation from countries where poliovirus is still circulating, and it gathers the information to recognize whenever vaccine-derived outbreaks occur. Having achieved elimination, Africa has the systems in place to recognize and manage both.

Reflecting on the summer of 1954, in the US, where hospitals in New York City were inundated by polio patients and my father, as a resident, spent the first months on the wards as the polio doctor, to the licensure of the first Salk polio vaccine in April, 1955, where he experienced the contrast as reflected by the virtual disappearance of the disease the following year, we have indeed come a long way. Having the right tools was a key ingredient for success. The Sabin oral trivalent polio vaccine became available in 1963, and was the mainstay of the global program, but the path has not been easy.

Innovation has remained a critical ingredient throughout the entire path towards eradication. Novel tools added to the polio kit include molecular epidemiology to track the origin of detected cases and environmental surveillance to identify areas with active virus transmission as reflected by viral shedding. On top of that, scientists are currently working on a new oral vaccine with reduced risk of leading to vaccine-derived polio outbreaks, one of the greatest concerns of the polio community at this point.

The experience in Africa has also taught us critical lessons for global health. Nigeria, where the last African case was recorded four years ago, shows the importance of engaging local communities and building trust relationships, the way the country overcame rumors that polio vaccines were contaminated with HIV and hormones to sterilize Muslim populations, leading to a temporary suspension of vaccination campaigns in the North of the country.

The experience in Africa has also taught us critical lessons for global health. Nigeria, where the last African case was recorded four years ago, shows the importance of engaging local communities and building trust relationships

As we celebrate the elimination of polio in Africa, work continues in Afghanistan and Pakistan, the only two countries that are now polio endemic out of the 125 when the Global Polio Eradication program was launched in 1988. In 2019, both countries reported fewer than 200 cases, a tiny number compared to the 350,000 children paralyzed annually before the eradication campaign began. This will still require the last battle to bring this number down to zero.

In the context of efforts to contain the impact of the COVID-19 pandemic, we need to ensure that the gains in polio are not reversed, and that we continue to advance towards the final goal of polio eradication. Today, we have reasons for optimism: elimination in Africa is a reflection of human resilience and aspiration and a harbinger for what can be achieved when science is combined with partnership, coordination, much hard work and imagination.