2023 – Zero-dose children key to success in seven sub-national sequential geographies

Zero dose: 2023 is an important year for the global effort to eradicate polio. This is the year where the GPEI Polio Eradication Strategy 2022-2026 plans to completely interrupt all remaining poliovirus transmission globally. A unique epidemiological window of opportunity is presenting itself at the start of the year, which we must take advantage of. So what is the focus of the program to achieve success this year? The answer is: reaching zero-dose children in the most consequential geographic areas.

In two countries that are endemic for wild poliovirus – Pakistan and Afghanistan – virus transmission is more restricted geographically than ever before. For example, in Pakistan, all cases in 2022 were concentrated in just six districts of one province, out of a total of 180 districts in the country. But more importantly, the biodiversity of the virus (that is, the different virus lines actively circulating in the country) continues to decline.

In 2020, the country was affected by 11 separate and individual chains of transmission, and this decreased to four in 2021, and only one chain in 2022. This means that individual virus lines are being successfully eliminated. The situation is very similar in Afghanistan, and coincidentally, we saw the same in other countries as they approached their final eradication efforts, notably India, Nigeria and Egypt.

The virus is now at its weakest, and the opportunity to completely eradicate it is now at its greatest. How do we do it? Very concretely, it means focusing all efforts on the ‘most consequential geographies’. are the regions that have the greatest impact on the global eradication effort.

But what are the most consequential geographies? Simply put, they are seven subregional regions around the world (eastern Afghanistan; southern Khyber Pakhtunkhwa, Pakistan; Tete Province and its hinterland in northern Mozambique; eastern Democratic Republic of the Congo; northern Yemen; northern Nigeria; south- Central Somalia).

These areas share some key programmatic characteristics: they have the highest and most densely populated proportions of zero-dose children (children who are either non- or under-vaccinated), and they are the most vulnerable to widespread humanitarian, complex emergencies. are also affected, including some areas of vulnerability, meaning that reaching these most marginalized and last-remaining under-vaccinated communities is all the more challenging.

Map of polio cases around the world

Our overriding programmatic goal should be to adapt our operations to reflect the nature of complex humanitarian emergencies in these seven sub-national most-consequence geographies. With a single and clear goal: to reach the remaining children with zero dose. It means working concisely and effectively in a wider human context, and that’s what we’re doing. We work with a wide range of humanitarian partners, we work through a network of co-ordination such as emergency operations centres, or emergency ‘cells’, to ensure that we respond, in a culturally relevant and appropriate way, to the wider Provide polio vaccine along with interventions.

Polio control crisis in the shadow of war
Polio has definitely re-emerged in the past year in places that were long polio-free. Such events certainly must be managed, and are being managed actively and successfully, by local public health authorities. But more than anything, events like this serve as a strong reminder of the need to meet the task of global eradication. This is the nature of attempting to eradicate a highly contagious disease that spreads easily with population movements, such incidents will continue to occur until polio is eradicated from all regions. In that context, it is important that countries continue their own national efforts to protect themselves in both the short and long term, by continuing strong disease surveillance and high vaccination coverage, and by fully implementing prevention activities. .

Finally: In 2023, a very real window of opportunity for success presents itself. But this window will not remain open for long.

To achieve success now, the focus of all partners and stakeholders must be: reaching zero-dose children in the most consequential geographic areas. All stakeholders have a role to play in achieving this. We have a collective responsibility. If we maintain this focus, success will follow.