Africa's triumph over wild polio shows the power of regional unity | Matshidiso Moeti

The legacy of a successful battle is now helping combat Covid, but we must stay vigilant, says WHO’s Africa regional director

Africa has declared victory over a virus that once paralysed 75,000 children on the continent every year.

Four years have now passed since wild polio was last detected in Africa. After a year of rigorously evaluating polio data from all 47 countries in the WHO’s African region, an independent body of experts announced during a virtual ceremony on Tuesdaythat the continent was free of wild polio.

The magnitude of this achievement cannot be overstated. It should inspire confidence in Africa’s ability to overcome even the most formidable public health challenges.

How we got here is a remarkable story that shows what Africa can achieve when its nations unite behind a common goal.

In 1996, African heads of state committed to eradicating polio at a session of the Organisation of African Unity in Yaoundé, Cameroon. That year, Nelson Mandela launched the Kick Polio Out of Africa campaign, with the support of Rotary International. Africans answered his call, setting in motion historic levels of international cooperation. In 2000, the first multi-country synchronised polio vaccination campaigns reached 76 million children across 17 countries in west and central Africa. Two million of these children had never been vaccinated.

Sixteen years and billions – yes, billions – of vaccinations later, Africa’s last wild poliovirus outbreak hit northern Nigeria. Recognising the risk, the region rapidly mobilised a response. With support from the Global Polio Eradication Initiative (GPEI), a taskforce was set up to help Nigeria, Niger, Cameroon, Chad and the Central African Republic coordinate and roll out an emergency outbreak response campaign to reach 45 million children.

Multinational campaigns on this scale are extraordinarily complex. Each country’s surveillance and vaccination teams work to implement campaigns over vast areas, using detailed micro-planning to ensure every settlement is reached.

The diversity of Africa’s terrain, cultures and languages, along with the disruption of health systems because of migration, conflict and climate change, have created additional challenges.

Africa’s polio eradication programme responded to these obstacles by constantly innovating and adapting its strategies. The programme developed a unique technique to reach children in insecure areas of the Lake Chad basin. Special transit teams were established in fixed locations with heavy traffic, such as markets and border checkpoints. In 2017 alone, transit teams stationed in one Nigerian city vaccinated 299,000 children moving out of conflict-affected areas of Borno state.

Reaching children in the most remote and insecure corners of the continent has not been easy. Some health workers lost their lives and I pay tribute to them. Their sacrifices have led us to where we are today.

The infrastructure and expertise developed to fight polio have played a major role in strengthening other health services. In Chad, polio vaccination strategies are used to reach nomadic populations with perinatal healthcare and routine immunisation services. Across the continent, thousands of workers integrate surveillance for other diseases in their search for polio cases, which has helped scale up surveillance networks.

Today, the polio programme plays an important role in Africa’s fight against Covid-19. Staff and resources are supporting countries to coordinate outbreak responses, educate the public and conduct contact tracing, data management and surveillance.

But history tells us that we must remain vigilant. While the wild virus is no longer circulating in Africa, it continues to infect children in Pakistan and Afghanistan. In the early 2000s, international spread of wild polio from India to several African countries showed how easily the virus can reappear if we let our guard down. Until polio is eradicated globally, all countries need to maintain high population immunity levels.

High vaccination rates are also needed to stop outbreaks of circulating vaccine-derived polio (cVDPV), which can occur when not enough children receive the oral polio vaccine. Sixteen countries are currently experiencing cVDPV outbreaks and the pause in vaccination programmes during Covid-19 is expected to increase transmissions. But it’s encouraging that some countries have restarted cVDPV response campaigns, under coronavirus pandemic control guidelines.

Tuesday’s certification ceremony – attended virtually by heads of state, health ministers, GPEI leaders and programme funders – was a moment to honour the heroic vaccinators, experts and community mobilisers who made this historic achievement possible. Amid celebrations, we must remember that this progress is fragile. We must redouble our commitment to keep wild polio out of Africa, and end cVDPVs.

The path ahead will not be easy, faced as we are with the new obstacle of Covid-19, but we have overcome setbacks before. And we are now armed with expertise and infrastructure developed by the polio programme over decades, and proof that no challenge can shake the commitment of African leaders and people.

The triumph over wild polio leaves no doubt in my mind that when we act together, Africa can achieve the most ambitious goals.

  • Matshidiso Moeti is the World Health Organization’s regional director for Africa

Matshidiso Moeti

The GuardianTramp

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