One year ago, I joined African leaders, experts, and global partners to mark an extraordinary milestone in global health. After a decades-long fight, children across Africa were finally free of polio caused by wild poliovirus, a bright moment in a year otherwise darkened by the Covid-19 pandemic.
Wild poliovirus can cause polio, an infectious disease that targets the nervous system and may result in paralysis, or even death. Polio mostly affects children under age 5 and can spread rapidly in areas where hygiene and sanitation can be a challenge. It is transmitted mainly when an infected child sheds the virus into the environment through feces and an unvaccinated child consumes contaminated food or drink, though it can sometimes be spread by a sneeze or cough from an infected individual. Polio cases have fallen 99% worldwide since 1988 and, with the achievement in Africa, the wild form now exists only in Pakistan and Afghanistan.
This success was no fluke. It was achieved because governments, health workers, partners, and country and community leaders heeded Nelson Mandela’s call 25 years ago to kick polio out of Africa and mobilized against the disease. The collective efforts and sustained commitments to reach every child with polio vaccines enabled African countries to move from 75,000 children paralyzed by wild polio in 1996 to zero children today.
But the job is not finished. Another form of the virus, circulating vaccine-derived poliovirus, is still infecting children across the continent. This type of polio occurs in communities where too few children received the polio vaccine, enabling the live, weakened virus contained in the oral polio vaccine to circulate in the environment long enough to mutate to a form that can cause paralysis. In 2020, the global number of cases of this variant were three times higher than in 2019, with nearly 1,000 children paralyzed. About half of the cases were in Africa.
Pauses and interruptions in the delivery of polio vaccines caused by the Covid-19 pandemic are one reason behind the spike, as 13 countries in Africa postponed the polio vaccination campaigns planned for response to the threat or detection of circulating vaccine-derived polio between March and July 2020. This was done intentionally to prevent the spread of Covid-19 among health workers and communities
But Covid-19 is not solely to blame. Some countries did not give urgent priority to polio outbreaks, and not all of the vaccination campaigns reached the high number of vulnerable children required, so the circulating vaccine-derived polio outbreaks continued.
The polio program has overcome challenges like these before, as Africa’s collective victory against wild polio can attest to. Yet every country in Africa and beyond must continue to apply the lessons learned from beating this disease to ending all forms of polio once and for all.
This is why I recently convened ministers of health and leaders from 47 countries in Africa who reaffirmed their commitment to defeating all forms of polio and to ensuring that Africa plays its part in eradicating polio around the world.
We have a blueprint to support countries in carrying out this work. In June, the Global Polio Eradication Initiative launched a new strategy that provides the tools and tactics that any country, with support from global partners, can implement to wipe out outbreaks.
These tactics include rapidly deploying surge staff to help countries respond to outbreaks as soon as they are detected, building on the experience and success of expert rapid-response teams based in the WHO Regional Office for Africa. Such teams have been deployed several times to support countries in stopping outbreaks of circulating vaccine-derived polio.
Countries in Africa will also continue to expand the rollout of an important tool for eradicating polio — the type 2 novel oral polio vaccine — which several countries started using in March 2021. This vaccine could more sustainably end outbreaks of circulating vaccine-derived polio. Close to 40 million doses of it have already been administered in six African countries, with more lined up to follow.
To further strengthen responses to the outbreak of circulating vaccine-derived poliovirus, Global Polio Eradication Initiative partners and country leaders will build on the program’s work delivering polio vaccines alongside essential health services, which can help build trust with communities that lack access to other forms of care and encourage the uptake of polio vaccines. This includes continuing to deliver essential immunizations against other diseases such as measles, diphtheria and tetanus; distributing bed nets to prevent malaria; providing care for mothers and newborns; and providing children with nutrition supplements like vitamin A tablets.
The recent commitment from African leaders to prioritize the response to this remaining form of polio is an important step to make sure no more children are paralyzed by this disabling and deadly disease. Committing to ending polio can yield benefits far beyond ending this one disease. More than half of the polio program’s surge staff in Africa currently support Covid-19 surveillance, contact tracing, community outreach, coordination, and other logistics, as they did against Ebola in 2014, continuing the program’s legacy of being at the forefront of tackling emerging health threats.
As Covid-19 continues to surge, every country in Africa is facing competing demands. But efforts to control Covid-19 should not allow other diseases — preventable diseases — to spread. This new pandemic has shown us the danger that even small pockets of disease can pose to an entire population. This applies to polio too, which will always threaten to resurge unless it is eradicated.
Matshidiso Moeti is a physician and health leader with 40 years of experience in public health and has served for the past seven years as the World Health Organization’s regional director for Africa, the first woman to have been elected to that position.
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