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.

6 September 2020 – The polio programme is responding to 2 new polio outbreaks in the Eastern Mediterranean Region: one in Sudan, and one in Yemen. Both outbreaks are consequences of increasingly low levels of immunity, and each has paralysed children in populations that have been difficult or impossible to reach with routine or supplementary polio vaccination for extended periods of time.

In Sudan, the polio programme is responding to paralytic polio caused by vaccine-derived poliovirus type 2 (VDPV2). The virus has been detected in children in 9 states, as well as in 3 sewage samples in Khartoum, indicating widespread circulation. Vaccine-derived poliovirus type 2 is a strain of poliovirus that emerges and paralyses children in communities where immunization levels against polio are too low. Sudan is at high risk of further virus spread due to extensive population movement by nomadic communities and people displaced by conflict, and frequent movement between neighbouring countries.

In Yemen, paralytic polio caused by vaccine-derived poliovirus type 1 (VDPV1) has been detected in Sa’adah governorate, in the war-ravaged country’s north-west. The cases in Yemen are clustered in an area that has very low routine immunization levels, has been inaccessible to the polio programme since late 2018, and has been a source of growing concern for those reasons.