Victory over polio return

World Health Organisation (WHO)communication officer ovilxlexla bunya shares a tale of dedication that gave rise to Malawi’s triumph over polio.

In February 2022, the discovery of a three-year-old child paralysed by wild poliovirus in Lilongwe sent shockwaves in Malawi.

Eighteen months later, the case of a 14-year-old child in Ndirande, the most populous township in Blantyre City, changed the Ministry of Health’s focus from routine immunisation to vaccinating all children aged below 15 years to combat the outbreak.

The virus was genetically linked to a sequence detected two years earlier in Pakistan’s Sindh Province.

Swift action was imperative and within 24 hours, President Lazarus Chakwera declared a national public health emergency and response activities began immediately.

The response was led by the Ministry of Health and supported by the Global Polio Eradication Initiative (GPEI) and its partners to bridge immunity gaps and strengthen surveillance to detect, contain, respond and halt any further spread of the virus.

To bridge community immunity, between March 2022 and September 2023, six rounds of door-to-door polio vaccination campaigns were implemented nationwide targeting children aged five to 15 with progressive improvement in performance in each round. 

The successful implementation of each round was due to the commitment of the health of workers to leave no child behind. 

Going door-to-door, they trekked across hills, traversed long distances and reached hard-to-reach communities.

Lusungu Gondwe, a disease surveillance and control assistant at Chilobwe Health Centre in Blantyre, said the main aim was to ensure that all children are vaccinated.

“Apart from practising hygiene, the vaccine is the only effective way to protect our children. Polio has no cure. Once it hits, there is no turning back. It is therefore everyone’s duty, whether men or women, to ensure that our children are protected,” she said.

According to Minister of Health Khumbize Kandodo Chiponda, the healthcare workers’ unwavering commitment ensured no child was left unvaccinated.

Boots on the ground, the tireless staff contributed immensely to the response, as she stated in her speech at the World Health Assembly in May this year.

Beyond the campaigns, routine immunisation systems were also strengthened to expand reach and access for all.

Several outreach sites especially in hard-to-reach terrains were established.

Systems were also established to ensure continuity of routine immunisation services amid emerging emergencies, including cholera, Covid-19, climate-related floods and cyclones.

Strengthening surveillance

The response included the provision of immunisation services in internally displaced persons camps, refugee centres and temporary relocation sites.

WHO country representative Dr Neema Rusibamayila Kimambo explains that with support from WHO, Unicef and other GPEI partners, international and local surge staff were deployed at various stages of the response.

The teams supported gap-filling, knowledge and skill transfer in the vaccine-preventable disease surveillance.

This helped close staff shortages at both national and subnational levels.

Kimambo states: “To further enhance surveillance, WHO supported the establishment of an environmental surveillance system in Malawi. These sites have been critical in monitoring the enterovirus burden within environmental sites using sewage samples.

“The response involved intensified cross-border collaboration in surveillance given the simultaneous outbreak in Mozambique. Through strong inter-governmental collaboration and joint planning, key activities such as synchronised campaigns, cross-border surveillance meetings and joint review sessions facilitated enhanced monitoring across borders as viruses know no geographical barriers.”

Innovating

Innovation played a pivotal role in the fight against polio.

Increased supervision in districts improved campaign efficiency with the use of real-time and geo-mapped electronic monitoring systems to ensure accountability, visibility and effective use of data to inform decision-making with support from the WHO.

Unicef supported the use of drones to deliver vaccines to distant areas, bridging geographical gaps.

On its part, WHO piloted the use of mobile money digital payment systems for reimbursement of activity funds for health workers.

This mobile money platform ensured timely payments to health workers, reducing missed transactions, and ensuring health workers’ motivation and satisfaction.

Victory at last

In May 2024, an independent Polio Outbreak Response Assessment Team conducted two in-country assessments and reviewed key documents to understand the possible spread of polio.

The expert group declared Malawi and Mozambique as having no evidence of ongoing wild poliovirus (Type 1) transmission.

This marked the end of the outbreak in the WHO African region.

The virus had been interrupted, WHO states.

Following this declaration, Malawi received well-deserved recognition at the World Health Assembly.

This success reaffirms a timeless belief: Where there is political will, collaboration, community engagement, multi-sectoral support and innovative technology, health outcomes can improve dramatically.

Malawi’s triumph over polio testifies to a take of dedication, which makes the country a beacon of hope for global health.