MOHAMMED MUKHIER and MATSHIDISO MOETI
Africa has reached a momentous milestone which underlines that the continent can overcome seemingly impossible health challenges such as COVID-19. Today (25 August) an independent body of experts has certified the World Health Organization (WHO) African Region as free of wild poliovirus. This is only the second virus in history to be eradicated from the continent since the eradication of smallpox 40 years ago. The achievement—which comes after years of collective effort and determined progress—provides crucial lessons to sustain immunization generally, and to help stop the spread of COVID-19.
Our first lesson during the campaign to eradicate polio was that—even though the polio campaign was set up as a standalone programme—community adoption was greatly increased when polio eradication efforts were made part of a broader package of community health measures. While responding to polio outbreaks, our teams and partners approached the eradication of polio not as a separate issue, but as an integral part of a broader package of preventative community health, which involved, among other interventions, routine immunization. This lesson was reconfirmed during our response to the Ebola outbreak in North Kivu, in the Democratic Republic of Congo (DRC): communities respond better when responders adopt a comprehensive approach which addresses not only that particular disease outbreak, but also broader health and humanitarian needs. In the case of COVID-19, this means saving lives, while sustaining livelihoods and access to routine health care.
Secondly, communities and local actors hold the key to ending diseases. This is crucial. Local actors understand the concerns and challenges of their own communities and are well placed to respond swiftly, even under the most difficult circumstances. For instance, when an outbreak of polio occurred in the Dadaab refugee camp in Kenya in 2013, a camp in which health care workers had previously been unable to operate due to mistrust and insecurity, the Kenya Red Cross Society was initially the only trusted actor who could start a vaccination programme. Today, seven years later, COVID-19 cases have been reported in the same refugee camp. And as in 2013 during the polio outbreak, well-prepared camp residents, working with trusted local social and health workers, are best placed to help detect COVID-19 and to stop its spread.
The last lesson we learned was that no one is safe until everyone is safe. While we celebrate the end of wild polio in Africa, we should be mindful that there is the risk that the gains are fragile. Wild poliovirus continues to infect children in Pakistan and Afghanistan. We also need high vaccination rates to stop outbreaks of circulating vaccine derived polio which can occur when not enough children receive the oral polio vaccine. The COVID-19 pandemic has disrupted disease surveillance and mass polio vaccination campaigns. Some countries are resuming these activities, but we expect that cases of circulating vaccine derived polio may increase due to the temporary halt in activities.
We call upon Governments and partners to continue supporting immunization programmes, while ensuring all communities have equitable access to vaccines.
In the context of COVID-19, the same applies. We urge stakeholders to ensure that COVID-19 vaccines are available to everyone and that Africa does not end up at the back of the queue. WHO, Gavi, the Vaccine Alliance, the Coalition for Epidemic Preparedness Innovations and other partners have launched the COVAX Facility to accelerate the development, production and equitable access to COVID-19 vaccines.
Crucially, polio taught us that trust and access are essential to reaching needed immunization thresholds. That is why, once again, when COVID-19 vaccines are available, a key success factor will be working with local volunteers, who are trusted by communities. An evaluation of the IFRC contributions to the 2009 Africa polio outbreak response found that the role of local teams have been crucial because volunteers were able to reach communities that were less accessible to Governments or other agencies. IFRC volunteers were welcomed into homes and played a key role in promoting the need for immunization.
It is our hope that the lessons of the past can be replicated in our current efforts to protect gains in child health and contain COVID-19. Thomson Reuters Foundation.
- Mohammed Mukhier is the Regional Director for Africa at the International Federation of Red Cross and Red Crescent Societies, and Dr Matshidiso Moeti is the World Health Organization Regional Director for Africa.