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Polio vaccination: real world challenges and solutions

Girl receiving oral polio vaccine

To what ends will a health worker go in order to reach children who need protection from disease? Volunteers walk miles, often barefoot, across rocky terrain and over rivers, often to reach just four families with a cooler bag containing precious shots of polio vaccine.  I learned about the work of these vital health professionals who vaccinate in remote, mountainous regions when I visited the Bill and Melinda Gates Foundation in Seattle recently, for a meeting which brought together different groups to talk under the theme of ‘taking risks’.

Real world challenges

One speaker was Ananda Bandyopadhay, ‘epidemiologist and polio eradication foot soldier’ according to his Twitter handle, who is also one of the Foundation’s senior program officers.  “It isn’t a vaccine that matters in the real world – what matters is the vaccination.  A vaccine in a vial, sealed off, is zero percent effective.  The challenge is reaching people,” he stated, showing a slide of an 80-year-old female volunteer walking with some determination through mud in an Afghan village to reach two young children who needed a polio vaccination.

CPolio (wild virus) incidence according to WHO’s Case Count

CPolio (wild virus) incidence according to WHO’s Case Count, 19/08/15. Yellow = 1-10, orange = 21-30 confirmed casesaption

From a worldwide tally of 350,000 polio cases in more than 125 countries in 1988, the map has now shrunk to two countries, Pakistan and Afghanistan, where the wild strains of the polio virus still exist.  There were just 74 cases reported last year.   This represents a tremendous step forward, but if we want to eradicate polio for good, it’s vital to keep up the momentum of the vaccination programme to stop any resurgence of this highly infectious disease.  But this is not easy. Apart from the geographical challenges of mountains and floods, the threat comes from groups who for religious reasons do not want to see families vaccinated.  “I never imagined I would see a situation where health workers are killed because they are going out to protect children,” said Bandyopadhay.

Some of the volunteers demonstrate immense resilience in reaching these remote communities, so do the planners, the monitoring staff and the logistics teams.  The world is so tantalisingly close to seeing the eradication of polio for good, but there is still more to do.  The positive news is that the global surveillance system, based on unparalleled partnership working, which was set up to fight polio has had a long lasting impact,  with some of the lessons learnt now being used to combat the Zika virus, and to control measles outbreaks.

Role of the Gates Foundation

So partnership in polio has been about overcoming seeming insurmountable barriers – geographical, political, financial, scientific.  I met the Gates Foundation’s CEO, Sue Desmond-Hellman, a former cancer physician and biotechnology leader, who spoke about how they deal with the setbacks and frustrations of advances not coming as quickly as they would always want.  She has just taken the step of publishing a letter which sets out the organisation’s successes and failures, in a move designed to help open up the work of the Foundation to a wider audience amid concern that sometimes there is ‘fuzziness’ around its aims.

The Gates Foundation, with its $40 billion fund, has the financial and political clout to bring people together, but as Desmond-Hellman points out, “in-country partners are critical to creating and demonstrating innovative approaches that are grounded in local realities.”  During my two days at the Foundation, I heard the staff talk a lot about the ‘real world’ and the fact that their aspirations can be quickly bogged down by inertia and a lack of understanding.  Desmond-Hellman said she had learned a lot about the essential importance of the supply chain. “The critical factor is that our partners have the capability to implement a supply chain effectively and the more that we can be clear about this capability need, the better the partnership will be,” she explained.  But as she puts it, solving problems takes time and capacity building is slow work, so their slogan of being ‘impatient optimists’ sometimes means the impatience will grow because the ‘real world’ cannot allow things to happen.

The global view

Last week saw members of the World Health Assembly meet to discuss the latest evidence regarding polio eradication.   As Dr Margaret Chan, Director General of the World Health Organization, said, “We have never been so close. During a fortnight in April this year, 155 countries successfully switched from trivalent to bivalent oral polio vaccine, which protects against the two remaining wild strains (type 1 and 3), making this the largest coordinated vaccine withdrawal in history. I thank you and your country teams for this marvellous feat.”

In our work at the British Society for Immunology, we do much to support those researchers working to understand immune responses and push back the barriers to vaccine development, but we should also celebrate those out in the field working to deliver the vials.

Jo Revill, Chief Executive, British Society for Immunology

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Images: Girl receiving oral polio vaccine (C) CDC Global; World map (C) Pazuzupa/Wikimedia Commons