In August 2020, Africa was certified free of wild poliovirus. But new cases of the disease have emerged in Malawi and in Mozambique this year.
SciDev.Net spoke with Ephrem T. Lemango, the associate director of immunisation at the UN children's agency UNICEF, about the reasons behind the resurgence and what needs to be done to reset progress on polio eradication in Africa.
How has the polio eradication programme helped African countries?
The polio programme has been helpful in supporting countries to improve access to other vaccines against many vaccine-preventable diseases.
One important aspect is that polio vaccines, oral and injectable, are provided as part of the regular schedule in many countries. This has significantly contributed not only to the reduction of the number of children facing polio, but provided the required platform to provide other vaccines and other essential health services that promote children survival.
How can proper nutrition help in the fight against childhood polio?
The contribution of nutrition is related to building the immunity of a child. Overall, nutrition contributes to child survival and decreases child mortality.
Regardless of the disease that affects children, nutrition builds the immunity of a child and protects a child against any forms of diseases. Any child who is undernourished will be more vulnerable to any type of infection as their immune systems are weakened. Ensuring that children are well nourished is part of the fight against any infection, including polio.
What are the reasons for the resurgence of polio in Africa?
Whenever there is a resurgence of polio, it shows that there are countries with weak health systems. These new cases show the importance of investing in health systems.
This is because if you have a strong immunisation system with regular delivery of vaccination services in hard-to-reach areas, then there is a great potential to maintain polio-free status.
This shows the need to invest in strengthening health systems. This requires governments to be able to double down on their financial support to primary health care and immunisation programmes and make sure vaccines are accessible to all.
A good example is the growing number of polio cases over the last several years as a result of circulating vaccine derived polio viruses, which is the result of the vaccine itself, and low immunity of selected communities.
But, due to subsequent vaccination using a novel oral poliovirus vaccine, cases have significantly decreased in places such as Nigeria from 60 per cent to 70 per cent.
This shows that polio programme can emerge from the setbacks. The cases in Malawi and Mozambique requires us to pay close attention.
As some forms of polio virus are derived from a vaccine itself, how can we continue to convince people to have their children vaccinated against polio?
This is an important question and does require a clear framing. One is the benefit of taking the vaccine continues to outweigh the negatives. If a child is not vaccinated against polio, the likelihood of that child having a polio-related paralysis is very high, especially in communities where there is low immunity.
If we don't want to go decades back where close to 400,000 children used to be paralysed every year, it is important that we continue to immunise newborns and women of childbearing age so that we are able to build strong immunity.
Luckily, we have what we call the novel oral polio vaccine (OVP), which is a separate type of vaccine, similar to the one used in the past but with less ability to become infectious and circulate.
What are the effective ways of sharing information about the novel polio vaccine?
Currently, the regular way of communication is using the mainstream media including radio that people have access to.
Creating better uptake of vaccines requires us to use frontline health workers to disseminate the right information to parents, households and communities.
The second step is to use influential people at the community level. This includes religious leaders and cultural leaders who are able to influence the opinions of communities. This method has been quite successfully in a lot of countries.
How do we fight vaccine opponents and the proliferation of fake news about vaccines?
The impact of vaccine opponents on access to vaccines, especially on the African continent, is limited. The major reason that households and communities do not take a vaccine is because it's not accessible. That's very important.
At the African continent level, there is an increasing access to social media. And what we advise is to counteract this misinformation by providing a positive information and by providing correct information about both the impacts, positive impact and of course side effects associated with vaccines, using trusted people, mainstream media and social media as well.
Can producing vaccines in Africa solve the vaccine funding challenge?
Vaccine production on the African continent is one of the ways to build resilient health systems. But it is not the silver bullet in the vaccine funding challenge. Producing vaccines requires a lot of investment.
It requires a continental level coordination to support the specific number of countries who have the right set of capacity including human capital.
It also requires policies that support vaccine manufacturing and the right investment to produce selected vaccines of importance that have comparative advantage. Africa can work on vaccine manufacturing, but there must be commitment not only to produce but also to buy from Africa. Because one risk is that so many countries build the capacity to manufacture vaccines, but if the rest of the African continent wants to buy vaccines from other countries other than Africa, then the value of producing it might be a challenge.
What we need is a pooled mechanism to produce vaccines that are not necessarily adequately available from the global market, and I understand there are efforts by the African Union and Africa CDC to do the same with a clear sense of purpose, with a clear sense of return on investment and comparative advantages.
What do you expect from the next forum on vaccination and polio eradication in Africa, taking place in Dakar on 10 December?
It's a very important forum that sends a strong signal for leaders of the African continent to take extra measures to continue to prioritise immunisation and eradication of polio in their health programmes.
The second thing is that this forum banks on the commitment made by heads of states of the African continent back in 2017 in Addis Ababa.
The commitment included the use of immunisation as an entry point to build stronger primary healthcare systems.
Progress was made but lost because of the COVID-19 pandemic. However, the pandemic also proved to be a bit of a blessing in disguise as investments made to slow the spread of the pandemic have been able to strengthen immunisation systems.
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So, this forum is very important to call for a recommitment by heads of states to this Addis Declaration on Immunisation that commits to providing vaccines for all, increase in vaccine investments and building vaccine manufacturing capacity on the African continent.
What other comments do you have on the fight against polio in Africa?
My final message is not specific to polio, but it does affect polio. We are at a critical time where almost 60 million children in the last three years have missed out on routine vaccinations globally because of the COVID-19 pandemic.
Thus, if we do nothing to address this, we will have so many outbreaks happening and there will be no guarantee that we will maintain the polio eradication pathway that we are on. Countries must treat this as an emergency and take extra actions to vaccinate missed children.
Disrupted systems must be addressed. Health workers that have been heavily focused on COVID-19 related work will need to return to the routine immunisation space so that they will be able to reach more children.
Most importantly, there is a need to continue to strengthen health systems.
This interview has been edited for clarity and brevity.
This piece was produced by SciDev.Net's Sub-Saharan Africa English desk.
This article was supported by Global Health Strategies (GHS), an organisation which uses advocacy, communications and policy analysis to improve health and wellbeing around the world.
H.E President Macky Sall, Chairperson of the African Union (AU) and President of the Republic of Senegal, will be hosting the Forum on Immunization and Polio Eradication in Africa on December 10, 2022, in Dakar, Senegal.
