Lessons from the elimination of poliomyelitis in Africa

Abstract

In August 2020, Africa was declared free of poliomyelitis (polio), bringing to fruition a goal that took more than 30 years to achieve. This Perspective chronicles global, continental, national and community actions taken by diverse stakeholders that finally led to the elimination of transmission of wild poliovirus in Africa. The cascade of events started with the development of polio vaccines and the realization that polio, much like smallpox, could be eradicated. After a 1988 pledge by the World Health Assembly to eradicate polio globally, concerted and deliberate efforts were made in Africa to achieve this goal. This included the use of evidence-based approaches for the harmonization and standardization of public health strategies, using a network of polio laboratories and emergency operation centres and actively pursuing underserved populations. Innovative solutions to counter challenges such as conflict and vaccine hesitancy may be of use in future public health interventions.

Strengthening vaccination delivery system resilience in the context of protracted humanitarian crisis: a realist-informed systematic review

“…Objectives for polio control (specifically eradication) are very different to those for many other VPDs where primary aims are more likely to be interruption chains of transmission in the context of outbreaks or to keep the burden of mortality and morbidity low in the face of endemicity (for diseases such as measles for example). This should not, however, preclude the use of infrastructure developed for polio control to support wider RI objectives, especially given calls elsewhere to consider how GPEI activities can better support routine immunisation delivery overall and lessons learnt through these regarding effective community engagement strategies in security-compromised areas [ 83 , 84 ].…”

Importation and Circulation of Vaccine-Derived Poliovirus Serotype 2, Senegal, 2020–2021

“…Because the international spread of VDPV continues to be a public health emergency of international concern, the GPEI should reinforce capacity of countries involved in both clinical and public health functions including surveillance, diagnosis, prevention, treatment, community immunization response, and research and health promotion targeting particularly the immunocompromised children, who can excrete the virus for several months, to limit its global transmission (32). Considering the introduction in Malawi and Mozambique of serotype 1 wild poliovirus imported from Pakistan (33,34), GPEI should implement urgent measures to forestall its spread such as routine immunization for members of the susceptible population who were missed or were only partially protected, to complement routine immunization and regular supplemental immunization activity in poliofree countries to prevent introduction of WPV and minimize the risk of circulating VDPV (35,36).…”

Threat of resurgence or hope for global eradication of poliovirus?

“…Today, global incidence of WPV has been reduced by 99.9% since the establishment of GPEI [12 & ]. The Americas, Western Pacific, and Europe were certified free of WPV by 2002, followed by South-East Asia in 2015, and Africa in 2020, leaving the Eastern Mediterranean as the only region with uninterrupted WPV type 1 transmission [3,[25][26][27]. Although WPV1 has remained endemic in Afghanistan and Pakistan, cases of cVDPV have been reported in more than 30 countries since 2019 [12 & ].…”