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KABUL, 13 December 2021 - The fourth round of a national polio immunization campaign begins this week (13–16 December 2021), and will be synchronized with Pakistan to improve cross-border polio eradication efforts. The campaign targets 9.9 million children aged 0–59 months across the country and is scheduled to start later this month in some parts of the country, including in the south and east, and in the provinces of Paktia and Ghazni in the south-east, Ghor in the west, and Balkh in the north.

This is the second campaign this year to reach children in areas previously inaccessible to the polio programme. A campaign in November 2021 delivered polio vaccinations to 8.5 million children under the age of five, including 2.4 million children who were vaccinated for the first time in over three years.

“We are intensifying efforts to reach the maximum number of children across the country, but we need sustained access to rapidly build immunity against polio, especially in areas we have not been able to reach in the last few years,” said Dr Dapeng Luo, WHO Representative in Afghanistan. “The November campaign was a massive leap forward and the upcoming campaign will further strengthen the progress we are making. Six more campaigns are planned for 2022 and we must ensure they are implemented in a timely fashion and reach all children,” he said.

To date, 2021 has been the year with the lowest polio transmission in both Afghanistan and Pakistan. This provides a great opportunity to interrupt transmission of wild poliovirus and achieve eradication.

Four wild poliovirus type 1 (WPV1) cases have been reported in the country so far this year. The first WPV1 case of 2021 was reported in January 2021 from Ghazni province in the south-east of the country, while the other three cases were reported in October and November from Kunduz province in the north-east.

The polio programme has put urgent measures in place to boost immunity in Kunduz and other high-risk areas to stop the polio outbreak and protect children from this crippling but preventable disease.

“Immunization is one of the most cost-effective public health interventions, saving children’s lives and contributing to a better future for Afghan children,” said Alice Akunga, UNICEF Representative a.i. “We must intensify our efforts to reach all children, especially those in greatest need, in order to bring polio disease under control,” she said.

Frontline workers are the pillar of successful vaccination drives. The polio programme is calling on all leaders, stakeholders and communities to ensure the safety of all frontline workers for the successful implementation of the campaign.

Having a public health workforce that is able to rapidly detect and respond to disease outbreaks is key for any health system, as recently shown on a worldwide scale with the current COVID-19 pandemic. The importance of this empowered and well-equipped resource is further emphasized by the International Health Regulations (2005), a legal instrument that encourages countries to prevent, detect and respond appropriately to disease outbreaks.

Taking measures to empower health workforce

To address Somalia’s limited capacity in this field, largely a result of decades of political instability, civil unrest, climatic shocks, and man-made and health emergencies, the National Institute of Health (NIH) of the Federal Ministry of Health and Human Services organized the Frontline Field Epidemiology Training Programme (FETP-Frontline), with support from the World Health Organization (WHO), the US Centers for Disease Control and Prevention (US CDC) and the Africa Field Epidemiology Network (AFENET).

The FETP-Frontline programme is a three-month on-the-job training course that addresses the critical skills needed to conduct surveillance and response activities effectively at the local level, focusing on improving disease detection, reporting and response. It is based on the premise that improving the epidemiological skills of staff from the Ministry of Health improves their ability to prevent, detect and respond to public health priority issues, which in turn would improve public health security in a country. It aims to improve field epidemiology knowledge, skills and competencies of trainees, and blends mentorship with classroom training and practical experiences to develop the public health workforce of a country. The trainees spend up to 12 days in three workshops and spend the remaining 8–10 weeks back at their jobs where they conduct field projects to practice, implement and reinforce what they have learned.  

 The FETP-Frontline programme is part of a three-tiered training model which is implemented in many countries based on the recognition that strengthening the capacity of the public health workforce, especially in fragile, vulnerable and conflict-affected countries, is critical at all levels of health system from the local to the regional and national levels. All three tiers use the same approach of condensed classroom instruction (< 25%) followed by field placements (> 75%) to gain experience and competence in field epidemiology.  The other two tiers of the training model are called FETP-Intermediate (a nine-month programme for staff based at regional or national level) and FETP-Advanced (a two-year full time programme for staff at national level).

Rolling out the first phase of the FETP training

The NIH kickstarted the 12-week long FETP-Frontline training programme with a first workshop, conducted from 29 August to 2 September 2021 for 26 participants, followed by the practical field experience, and a second training workshop that ran from 6 to 12 October 2021.

Dignitaries attending the launch of the FETP training on 29 August included: Dr Abdullahi Hashi Ali, Director-General of Health Services, who was representing HE Fawziya Abikar Nur, Minister of Health and Human Services for Somalia; Dr Mamunur Rahman Malik, WHO Representative to Somalia; representatives from the Intergovernmental Authority on Development (IGAD) Mission; and Dr Abdirahman Abdifatah, Director of the NIH for Somalia. Others who attended included the technical teams of the FETP from AFENET, as well as directors of health and social services from across Somalia’s states.

During the first of three tiers of training, the initial phase focused on training health workers at the frontlines on public health surveillance.

Streamlining reporting through field experiences

Adan Mohamed Ali, who serves the National Malaria Control Programme run by the Federal Ministry of Health and Human Services of Somalia, was one of the first 26 participants to attend the preliminary FETP training.

He explains that during the initial parts of the five-day classroom learning, he learnt a lot about disease surveillance, monitoring and evaluation, descriptive epidemiology and case investigation. As part of the on-the-job training, which comprises 75% of each training course, Adan visited health facilities in the district of Kahda, Banadir region. The second part of the training focused on presenting results, outbreak investigation and response, laboratory collection and transport, problem analysis and communication.

“While conducting the audit, I was supposed to visit six health facilities. However, only two were still functioning and one was reporting to the EWARN. I tried to convince the closed facilities to reopen to help in reporting and the search for diseases, which would help the Government to prevent spread of diseases in communities,” explains Aden. “Through the field exercise, I learnt how to identify the gaps and challenges of health facilities. I studied records for weeks 1–36 for this year, log books, tally sheets, charts and graphs and interviewed health facility staff to analyse the timeliness of reporting and discuss problems the staff face in reporting.”

He added that efforts like this were important as they would help the country’s health system to streamline reporting and surveillance for diseases.

Upon completion of the three-month FETP-Frontline training programme, Adan and other successful trainees will move on to the intermediate and advanced level courses, while at the same time becoming trainers for the next cohort.

Impact of the FETP

The evaluation of the first series of trainings shows an encouraging rise in trainees’ knowledge, which they are now applying in their daily work. The programme will help increase the capacity of Somalia’s health workforce in surveillance and outbreak response at all levels of service delivery. Indeed, demonstrable improvements in surveillance and response indicators, including the timeliness and completeness of reports, have been shown in other countries where the Frontline-FETP programme has been implemented extensively. Moreover, the training will develop the capacity of trainees and health facilities to detect and respond to disease outbreaks in a timely manner and minimize the spread of diseases to contain them. Trainees will also gain skills to communicate risk to the public and design messages that will support policy- and decision-makers to implement effective public health responses.

“The WHO country office for Somalia is fully committed to continue working alongside the NIH, CDC and AFENET to roll out the next steps of the FETP programme in Somalia, which will bring the country closer to bridging the current gap in the number of epidemiologists per 100 000 population in Somalia and build a strong cadre of disease detectives in line with the requirements of the International Health Regulations (2005),” said Dr Mamunur Rahman Malik, WHO Representative to Somalia.

“The Frontline-FETP is one of the outcomes of the strong collaboration between the Federal Ministry of Health and our health development partners in addressing the most critical challenges of our health system, which is human resources for health,” said Dr Abdifatah Ahmed, NIH Director.

“I’m a photographer, so my work depends on my sight.”

Tamer is a 39-year-old photojournalist from Rafah in the south of the Gaza Strip, working for the Associated Press (AP).

His sight has been deteriorating since he was diagnosed with a congenital eye condition in 2017. Tamer has required extensive treatments and investigations, not all available in the Gaza Strip. He received initial treatment in Gaza and Egypt, including corneal transplant and cataract operations. Due to the complexity of interventions needed, in February and September 2019 Tamer attempted twice to reach the eye clinic at Hadassah Ein Karim Hospital in Jerusalem but both times he was denied a permit by Israel to reach the hospital.

On the same day that Tamer’s second permit application was denied, he experienced a sudden worsening of his vision while traveling from Gaza City to his home in Khan Younis, in the south of the Gaza Strip. He was diagnosed with detachment of the retina at the back of his eye and needed urgent specialist intervention. The next month, October 2019, Tamer was approved a permit by Israel and Jordan for travel by direct shuttle to Jordan, for treatment in Amman. He traveled, but without any companion to accompany him.

“I needed somebody to guide me because my limited vision. People helped me along the way and in Jordan I asked strangers to help me until I reached the hospital. There the AP [Associated Press] manager in Jordan arrived and he helped me a lot during my stay.”

During his time in Jordan, Tamer saw his mother for the first time in nearly 20 years. She is Palestinian and lives in the town of Al-Lydd (Lod), to the west of Jerusalem. Because she has Israeli citizenship, she has not been able to visit her family in Gaza. Tamer had last seen his mother in Akka (Akko/Acre) in 2000.

Table 1: History of Tamer’s applications for an Israeli medical permit and outcomes

In Jordan, Tamer had laser treatment to his right eye and surgery in his left. From January 2020, he received his first permit approval to reach Hadassah Ein Karim Hospital in Jerusalem, and he traveled to the hospital six times between 4 January and 18 April.

“At Hadassah, they told me I would need surgery for my right eye as well, but it would only be possible after my left eye improved… I had smooth access to Hadassah up until [April]... After that, I lost five appointments. My last application for 1 August was not approved in time for my appointment.”

Tamer talked about how his illness and the uncertainty of accessing treatment has affected his health and his family life during these past years.

“I want to go back to what I had before, even half the vision I had before. I’ve gained weight and it hurts to stay at home and not be able to move like I used to. I’ll apply as many as needed to get a permit to reach treatment but waiting is unbearable. The AP [Associated Press] is trying and won’t stop until we get good news. I need the treatment; I can’t stay at home like this. I’ve had to bear this for three years.

My children are young, and my wife has supported me through all this. The kids see their father stay home rather than the active father they knew before – who was working, who took them out, who took them down to the beach. I’m not able to do any of those things with them now.”

As a photojournalist, Tamer worries about his work and his future.

“I’m so afraid of losing my sight. If I lose that, I won’t be able to work. I’m a photographer, so my work depends on my sight. I convey a message from behind the camera, but I can’t tell that message now.”

Tamer’s employer is trying to coordinate with Israeli authorities for his security clearance to travel.

Five million doses of COVID-19 vaccine have been delivered to Islamabad by the COVAX Facility’s global COVID-19 vaccine equity scheme so far.

ISLAMABAD, 17 July 2021 – Today 1 236 000 million doses of AstraZeneca COVID-19 vaccine reached Islamabad through the COVAX Facility, bringing the total number of doses delivered by the global COVID-19 vaccine equity scheme in Pakistan to five million so far. Since May, 2.4 million doses of AstraZeneca, 100 160 doses of Pfizer and 2.5 million doses of Moderna, the latter donated by the United States under the dose-sharing mechanism, have been delivered to Pakistan via COVAX.

“WHO applauds Pakistan’s globally recognized COVID-19 vaccination campaign. It is a remarkable achievement that COVID-19 vaccines are equitably made available to people even in the remotest areas of Pakistan. The vaccine roll-out has helped prevent COVID-19 infections, with its associated risk of hospitalization and death, and has reduced pressure on healthcare system,“ said Dr. Palitha Mahipala, WHO Representative in Pakistan.

“WHO will continue supporting the Government of Pakistan in setting up essential systems for swift and safe administration of vaccines. On behalf of the COVAX Facility, I reiterate that we will support Government of Pakistan with COVID-19 vaccines for around 20% of the population."

The vaccines will support the Government of Pakistan’s ongoing COVID-19 vaccination drive which started in February, one year after the first case was reported in the country. More than 4.5 million people have been fully vaccinated, and more than 18 million people partially vaccinated against the COVID-19 coronavirus so far. One million cases of COVID-19 have been reported and nearly 23 000 people have succumbed to the disease.

“This latest delivery comes at a critical time as the Government of Pakistan intensifies its vaccination campaign across the country. UNICEF is supporting global COVID-19 vaccination efforts through COVAX to maximize supply and access to safe, effective, and affordable vaccines,” said Aida Girma, UNICEF Representative in Pakistan.

”UNICEF will continue to support the Government in ensuring an efficient and effective management of all vaccination campaigns through procurement services of essential COVID-19, routine immunization and polio supplies; expansion of cold chain capacity to ensure safe storage of vaccines; and risk communication and community engagement to increase vaccine uptake and ensure adherence to COVID-19 safety measures.”

Strictly complying with COVID-19 safety measures remains crucial to curb the spread of virus. These include regularly washing hands with soap for at least 20 seconds or use a sanitizer; wearing a mask; remaining at least six feet away from other people; avoiding crowded places; and staying home when having COVID-19 symptoms. 

The COVAX Facility aims to help address the acute phase of the global pandemic by the end of 2021 by providing rapid, fair, and equitable access to approved vaccines to all participating countries, regardless of income level. It enables the protection of frontline health care and social workers, as well as other high-risk and vulnerable groups.

COVAX (COVID-19 Vaccines Global Access) is co-led by Gavi, the Coalition for Epidemic Preparedness Innovations (CEPI) and WHO, together with UNICEF. It is funded thanks to generous support from partner governments, foundations, and private sector corporations. So far, it has delivered more than 90 million doses of different COVID-19 vaccines to 133 countries and territories around the world.

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Photos can be downloaded here:

https://weshare.unicef.org/Folder/2AMZIFHBYAP5

For more information, please contact:

UNICEF

Catherine Weibel, UNICEF Pakistan, This email address is being protected from spambots. You need JavaScript enabled to view it., +92 300 500 2592

Abdul Sami Malik, UNICEF Pakistan, This email address is being protected from spambots. You need JavaScript enabled to view it., +92 300 855 6654

WHO

Maryam Yunus, WHO Pakistan, This email address is being protected from spambots. You need JavaScript enabled to view it., +92 300 8441744

Notes to editors

So far donors to the COVAX Advance Market Commitment include Austria, Belgium, Denmark, Estonia, France, Germany, Greece, Iceland, Ireland, Italy, Luxembourg, Netherlands, Norway, Spain, Sweden, European Union, Australia, Bhutan, Canada, Colombia, Japan, Korea, Kuwait, Monaco, New Zealand, Qatar, Saudi Arabia, Singapore, Switzerland, United Kingdom, United States, Anonymous Foundation, Bill & Melinda Gates Foundation, KS Relief/Gamers Without Borders, Mastercard, Medline International, Nikkei Inc., Reed Hastings and Patty Quillin, Shell, Thistledown Foundation, TikTok, Transferwise, Soccer Aid.

The list of donor pledges to COVAX AMC is available here.

About COVAX

COVAX, the vaccines pillar of the Access to COVID-19 Tools (ACT) Accelerator, is co-led by CEPI, Gavi and WHO – working in partnership with developed and developing country vaccine manufacturers, UNICEF, the World Bank, and others. It is the only global initiative that is working with governments and manufacturers to ensure COVID-19 vaccines are available worldwide to both higher-income and lower-income countries.

CEPI is leading on the COVAX vaccine research and development portfolio, investing in R&D across a variety of promising candidates, with the goal to support development of three safe and effective vaccines which can be made available to countries participating in the COVAX Facility. As part of this work, CEPI has secured first right of refusal to potentially over one billion doses for the COVAX Facility to a number of candidates, and made strategic investments in vaccine manufacturing, which includes reserving capacity to manufacture doses of COVAX vaccines at a network of facilities, and securing glass vials to hold 2 billion doses of vaccine. CEPI is also investing in the ‘next generation’ of vaccine candidates, which will give the world additional options to control COVID-19 in the future.

Gavi leads on procurement and elivery at scale for COVAX: designing and managing the COVAX Facility and the Gavi COVAX AMC and working with its traditional Alliance partners UNICEF and  WHO, along with governments, on country readiness and delivery. As part of this role, Gavi hosts the Office of the COVAX Facility to coordinate the operation and governance of the mechanism as a whole, holds financial and legal relationships with 193 Facility participants, and manages the COVAX Facility deals portfolio: negotiating advance purchase agreements with manufacturers of promising vaccine candidates to secure doses on behalf of all COVAX Facility participants. Gavi also coordinates design, operationalisation and fundraising for the Gavi COVAX AMC, the mechanism that provides access to donor-funded doses of vaccine to 92 lower-income economies. As part of this work, Gavi provides funding and oversight for UNICEF procurement and delivery of vaccines to all AMC participants – operationalising the advance purchase agreements between Gavi and manufacturers – as well as support for partners’ and governments work on readiness and delivery. This includes tailored support to governments, UNICEF, WHO and other partners for cold chain equipment, technical assistance, syringes, vehicles, and other aspects of the vastly complex logistical operation for delivery. Gavi also co-designed, raises funds for and supports the operationalisation of the AMC’s no-fault compensation mechanism as well as the COVAX Humanitarian Buffer.

WHO has multiple roles within COVAX: It provides normative guidance on vaccine policy, regulation, safety, R&D, allocation, and country readiness and delivery. Its Strategic Advisory Group of Experts (SAGE) on Immunization develops evidence-based immunization policy recommendations. Its Emergency Use Listing (EUL)/prequalification programmes ensure harmonized review and authorization across member states. It provides global coordination and member state support on vaccine safety monitoring. It developed the target product profiles for COVID-19 vaccines and provides R&D technical coordination. WHO leads, along with UNICEF, the support to countries as they prepare to receive and administer vaccines. The Country Readiness and Delivery (CRD) workstream includes Gavi and numerous other partners working at the global, regional, and countrylevel to provide tools, guidance, monitoring, and on the ground technical assistance for the planning and roll-out of the vaccines. Along with COVAX partners, WHO is also developing a no-fault compensation scheme as part of the time-limited indemnification and liability commitments.

UNICEF is leveraging its experience as the largest single vaccine buyer in the world and working with manufacturers and partners on the procurement of COVID-19 vaccine doses, as well as freight, logistics and storage. UNICEF already procures more than 2 billion doses of vaccines annually for routine immunization and outbreak response on behalf of nearly 100 countries. In collaboration with the PAHO Revolving Fund, UNICEF is leading efforts to procure and supply doses of COVID-19 vaccines for COVAX. In addition, UNICEF, Gavi and WHO are working with governments around the clock to ensure that countries are ready to receive the vaccines, with appropriate cold chain equipment in place and health workers trained to dispense them. UNICEF is also playing a lead role in efforts to foster trust in vaccines, delivering vaccine confidence communications and tracking and addressing misinformation around the world.

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About Gavi, the Vaccine Alliance

Gavi, the Vaccine Alliance is a public-private partnership that helps vaccinate half the world’s children against some of the world’s deadliest diseases. Since its inception in 2000, Gavi has helped to immunise a whole generation – over 822 million children – and prevented more than 14 million deaths, helping to halve child mortality in 73 lower-income countries. Gavi also plays a key role in improving global health security by supporting health systems as well as funding global stockpiles for Ebola, cholera, meningitis and yellow fever vaccines. After two decades of progress, Gavi is now focused on protecting the next generation and reaching the unvaccinated children still being left behind, employing innovative finance and the latest technology – from drones to biometrics – to save millions more lives, prevent outbreaks before they can spread and help countries on the road to self-sufficiency. Learn more at www.gavi.org and connect with us on Facebook and Twitter.

The Vaccine Alliance brings together developing country and donor governments, the World Health Organization, UNICEF, the World Bank, the vaccine industry, technical agencies, civil society, the Bill 4 & Melinda Gates Foundation and other private sector partners. View the full list of donor governments and other leading organizations that fund Gavi’s work here.

About UNICEF

UNICEF works in some of the world’s toughest places, to reach the world’s most disadvantaged children. Across 190 countries and territories, we work for every child, everywhere, to build a better world for everyone. For more information about UNICEF and its work for children, visit www.unicef.org and www.unicef.org/pakistan. For more information about COVID-19, visit www.unicef.org/coronavirus. Find out more about UNICEF’s work on the COVID-19 vaccines here, or about UNICEF’s work on immunization here. Follow UNICEF Pakistan on Twitter, Facebook and Instagram.

About WHO

The World Health Organization provides global leadership in public health within the United Nations system. Founded in 1948, WHO works with 194 Member States, across six regions and from more than 150 offices, to promote health, keep the world safe and serve the vulnerable. Our goal for 2019-2023 is to ensure that a billion more people have universal health coverage, to protect a billion more people from health emergencies, and provide a further billion people with better health and wellbeing.

For updates on COVID-19 and public health advice to protect yourself from coronavirus, visit www.who.int and follow WHO on Twitter, Facebook, Instagram, LinkedIn, TikTok, Pinterest, Snapchat, YouTube. Follow WHO Pakistan on Twitter and Facebook.