Canada contributes to crucial vaccinations during COVID-19 disruptions
Canadian Simona Zipursky, senior adviser to the Polio Director for the World Health Organization (WHO), in Bangkok, Thailand, has worked in polio eradication over the last decade. However, COVID-19 has changed how the world is reacting to many preventable diseases. “I never expected to be living in a time where there were active polio outbreaks we were choosing not to respond to,” she says. “It was a difficult decision to make.”
Polio invades the bloodstream and can be carried to the central nervous system, causing paralysis and death. Just like COVID-19, poliovirus affects people differently, with some asymptomatic spreaders.
The Global Polio Eradication Initiative was established in 1988 by a wide range of public and private donors, including Canada. Since then, 2.5 billion children were vaccinated and polio has been 99.9% eradicated, with pockets left only in Pakistan and Afghanistan.
But without vaccinations, the numbers were set to spike.
Safia Ibrahim is a Special Vaccination Representative with UNICEF. As a polio survivor herself, she is all too familiar with the life-altering damage a disease like this can do. “I contracted polio in Somalia when I was one year old,” says Ms. Ibrahim. “I remember wanting to play with other children, jump rope or hopscotch, but I couldn’t. I couldn’t go to school…I have seen the impact infectious diseases can have on children where access to health care is a challenge.”
Strengthening fragile health systems thanks to polio infrastructure
Ms. Ibrahim worries that the strain of a global pandemic is too much for fragile health care systems in developing countries. “As resources are diverted away from routine immunizations, more and more children will get sick or die from illness or disease that we have vaccines for,” she says.
Routine vaccinations improve the lives of children in developing countries because they can safely avoid preventable diseases—not only polio, but others like measles and tuberculosis.
Ms. Zipursky says they are using the existing infrastructure from polio eradication to fight COVID-19. “Basically, we have everything we need for disease detective work,” she says. “Rapid detection, strong surveillance networks, community-based vaccinators and coordinators at the district, provincial and country levels.”
This impressive work behind the scenes is also recognized by Pierre Blais, Deputy Director of Infectious Diseases at Global Affairs Canada. As one person in a team supporting programs in developing countries with both money and advice, he says the undertaking is out of this world. “It is like what the moon landing represented for the United States in the 1960s,” says Mr. Blais. “It’s a merging of leading-edge science, political aspirations, huge financial commitments, hard work, and outright courage and determination—all delivered in a war room atmosphere. We need to know what’s happening globally, but also tracking what’s happening in the field.”
Back in April, the Global Polio Eradication Initiative made resources available to respond to COVID-19 while maintaining surveillance. Because of this tracking, the WHO was aware of outbreaks cropping up around the world, but the risk of spreading COVID-19 put the program on pause.
This is not the first time the program has paused, but, as Ms. Zipursky explains, it is the most dramatic.
“In Sierra Leone the recent outbreak of Ebola interrupted our polio programs,” she says. “As with COVID, we had the expertise to focus on Ebola instead. There was a suspension, of course, but even though COVID is less deadly than Ebola, the global consequences are bigger.”
Immunization during the COVID-19 pandemic: rising to new challenges
A lack of protective equipment and the redistribution of resources from fragile health systems is putting millions of children in developing countries in harm's way.
The Global Polio Eradication Initiative advised countries to start planning for the safe resumption of polio vaccination campaigns, especially in countries at high risk for polio. Teams are now being supplied with the requisite gloves and sanitizers as campaigns restart in Pakistan from July. For workers on the ground, this can’t come too soon.
In Pakistan a vaccinator referred to as Ms. Robina, with the WHO’s Polio Relief unit, says the virus made the availability of supplies choppy. “At the very start, we, the health staff, were provided with masks, gloves and sanitizers free of cost,” she says. “And after that, we are buying [these items] by our own pocket.”
This was a concern shared by Razia Subhan in Lahore. “We wish that we are given plenty of sanitizers, gloves and masks that we can use,” she says. “Sometimes, people visit us even they don’t have masks. So they ask us for the masks. So if the program provides us with these things, this will be helpful.”
But the hurdles are not just on the logistics and supply side, they also come in the form of community perception. Parents may fear walking miles or travelling by public transport to clinics for routine vaccinations because of their own concerns about catching COVID-19.
Ms. Robina says parents are not keen to hang around clinics. “Every parent is interested to quickly vaccinate their children and get back to home. At this time, we felt some challenging behaviours from the parents. However, we guide them to maintain social distance within the health centre.”
Summer Iqbal is a vaccinator in Lahore who travels to see children in person. She says it takes time and conversation to convince some parents it is safe. “The problem that we are currently facing is not much, but in some cases, people refuse to [let us] vaccinate their children because of the fear of corona…. Then we went again after a month, and we talked to them, and they let us vaccinate the child.”
Workers for UNICEF in Afghanistan say while COVID-19 put a stop to their house-to-house polio immunization campaign, because of support from countries like Canada, polio social mobilizers from the community help families keep track of their children’s health records.
Canadian Melissa Corkum is a Polio Outbreak Response Senior Manager for UNICEF. She has worked in Afghanistan, Pakistan and Nigeria. Ms. Corkum agrees the process of tracking, financing and getting vaccines to where they need to be while keeping them chilled and ensuring no child is missed is a massive undertaking.
“I remain in awe of the work required to make ‘reaching every child’ possible, she says. “Women play a critical role at every step of the way, including raising awareness of the importance of immunization at the community level and vaccinating. These women are really on the front line in difficult circumstances where it costs lives.”
Vaccination to save lives
The bravery of those on the front lines is supporting a very cost-effective public health intervention to save lives and bring communities into regular contact with the health system.
Despite the progress achieved in recent decades, even without COVID- 19 on the scene, nearly 19 million children remain unimmunized every year. That is almost 20% of children born each year.
The disruption from this pandemic put at least a further 80 million children at risk of diseases such as diphtheria, measles and polio, according to a recent warning from the WHO, UNICEF and Gavi, the Vaccine Alliance.
Of note in this time of COVID-19 is that maintaining immunization programs will ensure the infrastructure is in place to roll out an eventual COVID-19 vaccine on a global scale.
Canada’s role yesterday, today and tomorrow
Canada announced nearly $500 million in international assistance toward the global fight against COVID-19 and $159.5 million to support global efforts to address the outbreak.
In June, a further $180 million was allocated toward humanitarian and developmental impacts of the pandemic, and $120 million was announced for a global collaboration to accelerate access to COVID-19 tests, treatments and eventual vaccines.
Canada previously announced a $600-million contribution to GAVI, the Vaccine Alliance, for the next five years and committed $47.5 million annually over four years to support the Global Polio Eradication Initiative’s Endgame Strategy.
Akhil Iyer, Director of the Polio Eradication Programme at UNICEF, says Canadian people have always played a major role in the historic fight against polio. “I am proud to be part of this endeavour as a Canadian citizen myself. Back in the 1950s in Canada, poliovirus outbreaks could have paralyzed or killed so many more children and could have plagued the economy and pushed millions [into] vicious circles of poverty and ill health.”
Before a vaccine was developed, polio spread in waves throughout North America in the first half of the past century and caused widespread panic that may seem familiar in 2020. As the Toronto Star newspaper reported: “Epidemics struck in 1931 and again in 1937. In Toronto, children were kept indoors, swimming pools, parks and churches were closed and the start of school delayed.”
COVID-19 has reminded Canadians once again that infectious diseases do not recognize borders.
Global Affairs Canada is working with partners to ensure who are most vulnerable, including women and children, have access to vaccinations to keep them healthy wherever they live.
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