Polio Eradication in Africa: Reaching Remote Communities

Polio Eradication in Africa: Reaching Remote Communities

By Keletso Thobega

It was a moment of joy and jubilation when wild polio was officially eradicated, signaling one less health challenge for Africa. However, the victory was hard-won, as reaching all communities across the continent, particularly the remote and disadvantaged ones, was no easy feat.

Developing sustainable supply chain systems to reach these remote communities became critical.

When Lucia Mbiki, who lives and works in Maputo, first heard about the polio vaccination drive, she was concerned that her child, who lives with relatives in the remote area of Marere, might not be reached. She was relieved to learn that there would be a nationwide event.

“It would have been costly to travel back home to take my son for immunization. I’m glad there was an effort to reach all communities,” she said.

Maria Mussa, a mother of four, was worried about whether there would be enough time to reach all communities. Mussa, who hails from Pena, witnessed many deaths from polio during her childhood. “Luckily, information dissemination and supply systems have improved,” she said.

Medical supply chains play a critical role in ensuring timely access to vaccines, especially in remote areas—a role that VillageReach, an organization that has operated for 20 years, has mastered.

Luciana Maxim, Director of Health Supply Chain & Lab System Strengthening at VillageReach, said they applied their expertise to improve the timeliness and quality of transportation for lab samples, including human and environmental samples suspected of polio.

At the end of 2021, VillageReach received funding from the Global Polio Eradication Initiative (GPEI) to conduct national assessments of lab sample referral and transport systems for polio in several African countries.

Maxim explained that the World Health Organization's (WHO) new target for all countries is to get human or environmental samples to a national or international lab within three days.

While the few polio cases left in Africa are vaccine-derived, the WHO AFRO region had been declared free of wild polio a couple of years earlier.

However, when wild polio was detected again in Malawi and Mozambique in early 2022, everyone went into emergency mode to contain these outbreaks as quickly as possible. It became imperative to get samples to labs swiftly, raise awareness at the community and health worker levels, and ensure that all children caught up on their routine immunizations after disruptions caused by COVID-19. VillageReach played a crucial role in these efforts, and the wild polio outbreaks were contained quickly that same year.

Maxim pointed out that 13 out of the 15 countries where they have been working since then have experienced vaccine-derived polio outbreaks, as well as outbreaks of other diseases like measles, yellow fever, and Ebola.

“We quickly realized that, to help suppress outbreaks quickly, we needed a more integrated approach that ensures samples for all outbreak-prone diseases reach labs within days. We took every opportunity to integrate resources, staff, and data across diseases and health system functions,” she said.

Tsedeye Girma, UNICEF’s Global Polio Outbreak Response Coordinator, emphasized the importance of building a decentralized presence and strong ties with communities.

“For example, we take a community-centric approach in engaging local communities as active partners in the fight to end polio. We recruited and trained thousands of local community members, including traditional leaders, religious leaders, polio survivors, women’s groups, youth, and other influential community figures, to work as polio outreach workers and mobilizers,” she said.

Across Africa, polio community mobilizers went door-to-door, creating awareness about the importance of polio vaccination and routine immunization.

“They speak the local language, understand local traditions and norms, and are familiar faces in their neighborhoods,” Girma said.

Since most households in Africa are female-led, and given cultural norms that restrict male health workers from entering households with only women, the majority of polio community mobilizers have been women.

“This approach makes all the difference in getting the message across and ensuring children are vaccinated,” she added.

To boost the vaccination campaign’s reach, UNICEF and other stakeholders meticulously crafted messages in a multitude of local languages. These messages were broadcast through megaphones by town announcers and mobile public announcement vans, which traveled from one community to another. They also partnered with local FM and community radio stations to announce polio campaign dates and spread polio prevention messages.

Managing vaccine misinformation remains a significant barrier to reaching children. Girma noted that community mobilizers play a key role in addressing parents' and caregivers' concerns about vaccines during their visits.

“We also use social listening tools to track and counter false information about vaccines, both online and offline. UNICEF’s digital community engagement program mobilizes over 70,000 online volunteers worldwide to counter misinformation and provide accurate and timely information about vaccines.”

UNICEF, as part of the GPEI, manages the supply of polio vaccines to help vaccinate over 400 million children annually and stop the transmission of the polio virus.

Girma highlighted that depending on the context, various modes of transport were used to get polio vaccines to the most remote health facilities.

“This includes refrigerated trucks, motorcycles, boats, pack animals, and even by foot. In some countries, like Malawi and Mozambique, we have even used drones to deliver vaccines,” she said.