Rotary Voices Podcast Summary Episode: Polio Update: Together, We End Polio
Release Date: October 24, 2024
Host: Nailah Boudu
Produced by: Rotary Magazine

Introduction

In this episode of Rotary Voices, host Nailah Boudu delves into the ongoing battle against polio, spotlighting recent outbreaks and the robust global response spearheaded by Rotary International and its partners. The discussion features insights from three distinguished experts: Dr. Hamid Jafre from the World Health Organization (WHO), Dr. Daniel Salas of the Pan American Health Organization (PAHO), and Dr. Varya Grabovok representing the Western Pacific region. Together, they explore the complexities of eradicating polio in regions where it has long been controlled and the vigilance required to maintain polio-free statuses globally.

Polio Outbreaks and Challenges

Guest: Dr. Hamid Jafre, Polio Eradication Director for the Eastern Mediterranean Region, WHO

Dr. Jafre discusses the alarming resurgence of polio in Pakistan and Afghanistan, highlighting the multifaceted challenges impeding eradication efforts.

• Epidemic Nature of Polio:
  “Polio is an epidemic-prone disease. If you do not interrupt its transmission, it will come back as an outbreak.” [01:48]

• Contextual vs. Programmatic Factors:
  As eradication efforts near completion, contextual factors like political stability become more critical than programmatic ones.
  “Progress is not really linear. You have these cycles until you sustain eradication efforts to a point that you can actually stop transmission.” [01:48]

• Primary Challenges:

  1. Insecurity:
     Conflict zones like Gaza, Sudan, Yemen, Somalia, and parts of Pakistan hinder access to vaccination.
     “Insecurity is a contextual factor because the program has some ability to mitigate, but it does not control insecurity and access.” [04:13]

  2. Social and Political Disconnect:
     Misinformation and unmet community needs lead to vaccine refusal and distrust.
     “Some services like roads are not there, schools are not there, health facilities are not there.” [04:13]

  3. Hard-to-Reach Populations:
     Mobile and migrant groups complicate vaccination efforts, exacerbated by cross-border movements.
     “Pakistan and Afghanistan both have extensive population movement, further complicated by extensive cross-border population movements.” [06:40]

  4. Programmatic Issues:
     Quality gaps in vaccination campaigns can lead to missed children and operational inefficiencies.
     “In the beginning, often the quality of the vaccination campaign is not that high and it takes some time to build to that level of quality.” [06:43]

• Genetic Clusters Explained:
  Dr. Jafre clarifies that polio viruses mutate and form clusters.
  “Polio viruses, as they replicate and spread, mutate and evolve into different families and then larger families become a cluster.” [06:43]

Case Study: Gaza Polio Outbreak

Guest: Dr. Hamid Jafre, WHO

The detection of poliovirus in Gaza Strip environmental samples and the subsequent case of a 10-month-old boy underscore the fragility of polio-free regions.

• Outbreak Response:
  Dr. Jafre details the rapid response and vaccination campaigns initiated in Gaza.
  “The first round has done better than our expectations. Micro planning was excellent by the teams on the ground.” [10:17]

• Community Engagement:
  Gaza's high health literacy facilitated a successful vaccination drive.
  “Overwhelmingly, the community was very, very avid in bringing their children to get the vaccine.” [10:17]

• Second Vaccination Round:
  Incorporation of additional health measures like Vitamin A supplementation enhances the campaign's impact without compromising quality.
  “The teams agreed to add Vitamin A to the polio vaccination campaign in the second round in Gaza.” [12:48]

• Regional Solidarity:
  Emphasizing a collective regional threat approach, neighboring countries like Jordan and UAE played supportive roles.
  “Regional solidarity is very important. Countries have demonstrated resilience and this support builds greater resilience across the region.” [12:44]

Lessons from India’s Eradication Effort

Guest: Dr. Hamid Jafre, WHO

Reflecting on India's successful polio eradication provides valuable lessons for ongoing efforts in Pakistan and Afghanistan.

• Non-Linear Progress:
  India experienced setbacks with periodic outbreaks before achieving eradication in January 2011.
  “Progress towards eradication is not linear. You go forward and then have a setback and then work through that again.” [16:04]

• National Commitment:
  Strong governmental dedication was pivotal in maintaining high vaccination standards and accountability.
  “The national commitment, the commitment of the government, is very important...” [16:04]

• Community Engagement and Rotary's Role:
  Engaging local communities and empowering Rotarians were crucial in overcoming resistance and logistical challenges.
  “The tremendous role that the Rotarians in India played... was crucial to get the elimination in the past.” [16:04]

• Inspirational Quote:
  Dr. Jafre cites Nelson Mandela to emphasize perseverance.
  “It always seems impossible until it's done.” [16:04]

Maintaining Polio-Free Status: Americas Region

Guest: Dr. Daniel Salas, Executive Manager, Comprehensive Immunization Program, PAHO

Celebrating 30 years without wild polio transmission, Dr. Salas underscores the necessity of sustained immunization efforts to prevent resurgence.

• Achievement and Vigilance:
  “We managed to eliminate the wild polio transmission in the Americas 30 years ago... but it's difficult to keep this target because you need strong immunization programs.” [22:08]

• Challenges:
  Competing public health priorities and maintaining high immunization coverage amidst changing societal dynamics.
  “Some policymakers are not totally aware of the benefits... We need to reinforce the message that vaccines are safe and effective.” [23:37]

• Vaccine Hesitancy:
  Addressing misconceptions and ensuring communities understand the importance of timely vaccinations.
  “Still, most people trust in vaccines, trust in routine vaccines, and that's something we need to capitalize on.” [26:16]

• Urban vs. Remote Access:
  Strategies vary between urban and rural settings, including adapting vaccination schedules and leveraging electronic registries.
  “In metropolitan areas, adaptation is key, like adjusting vaccinators' working hours.” [27:53]

• Technological Integration:
  Utilizing AI and electronic registries to identify and reach under-vaccinated populations.
  “Having a nominal registry for every single person makes it much easier to be more efficient.” [30:20]

• Role of Education:
  Strong investment in education correlates with better health outcomes and vaccine uptake.
  “Education is crucial because educated people can understand preventive measures more easily.” [31:13]

Maintaining Polio-Free Status: Western Pacific Region

Guest: Dr. Varya Grabovok, Regional Laboratory Coordinator for Vaccine Preventable Diseases, Western Pacific Region, WHO

The Western Pacific region has upheld its polio-free status since 2000 through rigorous surveillance and immunization strategies.

• Sustained Efforts:
  Implementation of high routine vaccination coverage, supplementary immunization activities, and strong surveillance systems.
  “We have successfully maintained our polio-free status by increasing and sustaining high routine vaccination coverage.” [34:46]

• Challenges:
  Risks from circulating vaccine-derived polioviruses (CVDPVs), inadequate immunization in certain areas, and importations from neighboring regions.
  “Importation of wild poliovirus type 1 from endemic countries poses ongoing risks.” [34:46]

• Surveillance and Response:
  Robust environmental and acute flaccid paralysis (AFP) surveillance supplemented by a high-capacity laboratory network ensures rapid detection and response to any new cases.
  “Environmental surveillance was used successfully as a supplement to AFP surveillance.” [37:14]

• Risk Assessment:
  Continuous evaluation identifies high-risk countries, enabling targeted interventions and preparedness.
  “Updated Risk Assessment categorized three countries as high risk for poliovirus transmission.” [37:14]

Conclusion

The Rotary Voices episode underscores the relentless global effort to eradicate polio, highlighting both triumphs and ongoing challenges. Experts emphasize that while significant progress has been made, maintaining high vaccination coverage, addressing contextual barriers, and fostering regional solidarity remain imperative. Rotary International's pivotal role in community engagement and fundraising is recognized as essential in the final push towards a polio-free world. The collective commitment of health organizations, governments, and communities offers hope that polio eradication will soon be realized.

Notable Quotes:

• “Polio is an epidemic-prone disease. If you do not interrupt its transmission, it will come back as an outbreak.” – Dr. Hamid Jafre [01:48]
• “It always seems impossible until it's done.” – Dr. Hamid Jafre [16:04]
• “Most people trust in vaccines, trust in routine vaccines, and that's something we need to capitalize on.” – Dr. Daniel Salas [26:16]

Join the Fight to End Polio:
Visit www.endpolio.org to support and participate in eradication efforts.

Credits:
Produced by JP Swenson with assistance from Kristin Morris, edited by Wen Huang, and produced by Yoo Soo Kim. Special thanks to Sarah Tetzloff and Carol Pandak.