After two decades working in global health and fighting dozens of polio outbreaks across Africa in countries like Cameroon, Madagascar, and Ethiopia, Dr. Fabien Diomande remains an optimist.
“The existence of multiple public health priorities represents a growing challenge. COVID-19, polio, meningitis, measles, they are not going to disappear tomorrow or the day after tomorrow,” said Diomande, Director of The Task Force’s Polio Surge Capacity Team. “That means we have to learn how to deal with multiple public health priorities at the same time. We also have to learn how to fund all these programs at the same time without neglecting any of them because they are all important. I think the world can learn. We have to adapt.”
Having witnessed first-hand the challenges and successes of the global campaign to end polio, Diomande has a unique perspective on World Polio Day (October 24).
When the Global Polio Eradication Initiative started in 1988, Diomande was in his first year of medical school in Abidjan, Côte d’Ivoire. At the time, more than 350,000 people in 125 countries were paralyzed due to polio. Today, wild poliovirus is endemic in only two countries, Afghanistan and Pakistan, with each reporting just one case so far this year.
“It’s important to recognize the achievement the global community has made thus far, but we must also remind people that we still have a lot to do,” said Diomande.
Diomande took a deep breath as he explained the remaining obstacles.
“Even if we have only two endemic countries, those two countries are very vulnerable because of political instability, but also other vulnerabilities like access issues and security,” said Diomande.
In addition to the risks of wild polio, vaccine-derived poliovirus outbreaks in about 35 countries pose another roadblock to eradication. Vaccine-derived poliovirus is caused by a combination of low vaccination rates and when the weakened live virus in the original oral vaccine reverts back to its paralytic form. Thankfully, there is a new oral vaccine being rolled out that is designed not to revert back to a paralytic form.
The Polio Eradication Surge Capacity Team provides strategic and operational support for polio outbreak responses, including in-country and remote technical support by senior epidemiologists, international and national consultants.
Diomande said before the COVID-19 crisis the key challenges to polio eradication were accessibility, security, and funding gaps.
“For example, in many African countries, reaching communities to bring them surveillance and immunization services can be difficult. Surveillance services are critical to detect and report disease cases, and guide outbreak response strategies. High coverage of immunization services is also very important to achieve high population immunity against vaccine preventable disease, including polio, and to stop the spreading of diseases in the population. Difficult terrain, insecurity, and population displacement, like refugees and internally displaced people, are the main barriers to delivering public health services.”
During the pandemic, there have been additional challenges, such as diverting human resources and funding for diseases like polio to pandemic response.
“Vaccine manufacturing, production, distribution, availability on a global level are also being impacted by COVID-19,” said Diomande, who cited additional complications. “The emergence of COVID-19 also comes with an increase in rumors against vaccines, an increase in vaccine hesitancy.”
This isn’t the first time Diomande has encountered that issue. In 2005 during a polio outbreak in Nigeria, he worked in a remote area in the north of the country on a World Health Organization project to provide technical assistance to strengthen outbreak preparedness and response activities. This included community sensitization and mobilization, surveillance strengthening, and polio campaigns preparation, implementation and evaluation.
“At that time, population resistance to polio vaccination was high, and we had to work hard to address vaccine hesitancy and its contributing factors at all levels including rumors, and at the same time improve the performance of surveillance and vaccination activities. Because we worked together and we recognized that any contribution of any person makes a difference, we were able to overcome challenges like vaccine hesitancy.”
That same spirit of collaboration continues to give him hope.
“In polio, the team spirit inspires me everyday,” he said. “The people you don’t hear about but we all succeed because of are truly essential — the people in the villages mobilizing people, convincing people to get the vaccine, fighting vaccine hesitancy, and reporting cases.”
In honor of World Polio Day, Diomande and other Task Force colleagues will discuss polio eradication efforts at a Rotary-sponsored virtual event on October 26th in Atlanta, GA.
“Polio has a huge impact on the life of an individual as well as the life of the community,” said Diomande. “Removing the burden of polio will be a huge achievement in public health.”
Header photo: Dr. Neveen Gerges administers a polio vaccine to a child in Cairo governorate in Egypt, during a vaccination campaign in February 2021. Photo courtesy of Egypt Field Epidemiology Training Program.