Going the extra mile to stop poliovirus spread

By Proscovia Nakibuuka Mbonye, Sara Awad and WHO Eastern Mediterranean Region

It’s day one of the polio vaccination campaign in Sudan’s Red Sea State, where poliovirus was detected in sewage samples earlier in 2024. At the crack of dawn, vaccinators set off with their vaccine carriers filled with ice packs and vials of oral polio vaccine and vitamin A to reach children in their communities. Their goal: vaccinate every child aged under 5 years in the state over the 4 days of the campaign.  

Since the conflict in Sudan began, in April 2023, health infrastructure and immunization services have been disrupted. Hundreds of thousands of children have been left unvaccinated and at risk of infection from vaccine-preventable diseases such as polio. This situation is made worse by the displacement of large numbers of people. 

When news of the positive poliovirus samples was reported, the Federal Ministry of Health sprang into action with the support of WHO and the United Nations Children’s Fund (UNICEF). After carrying out detailed investigations and risk assessments, a team of technical experts were deployed to identify various high-risk areas across Sudan requiring a response.  

By the time the campaign was launched in Red Sea State, communities were well aware of its aims. Social mobilizers had seized every chance to visit and sensitize communities to polio vaccination. Messages played on the radio and from loudspeakers on vehicles echoed across villages, urging parents and caregivers to vaccinate all children aged under 5 years in the upcoming polio vaccination campaign. Health teams also worked with partners to reach children in displaced families. 

At the Agig Health Centre, Mahmoud, a health worker and vaccinator for 10 years, collects vaccines for the catchment area he is covering on day 3 of the campaign.  

He plans to reach the mobile and hard-to-reach communities in Barqiq valley, in the mountains and along the border with Eritrea, where the nearest health facility is 40 km away. Until the start of May this year, these mobile communities will remain in the mountains. Come summer, they will travel to the countryside of Kassala State.  

"With these populations always on the move, there is a very real possibility that their children may miss out on vaccination activities,” says Mahmoud. “This means we have no time to waste in reaching these children."

With the vaccines stored safely in cool boxes and vaccine carriers to maintain the optimum temperature, the team embarks on the journey from Agig to Barqiq valley. They first travel by car but switch to camels and donkeys for the last 2 hours, as the roads get rougher and narrower. 

Drop by drop, children are protected

When Mahmoud and his team arrive, parents and caregivers are patiently waiting in a makeshift straw-roofed shelter. They all share one thing in common – the desire to protect their children from preventable life-threatening diseases.  

Fatima, mother to 4-year-old Mohammed, visited the health centre a few months ago. While her malnourished child received treatment, she was told about the upcoming polio campaign. She didn’t think twice about vaccinating her children, because she knows this is the best gift she can give them.  

“Every time the vaccinators arrive, I take my children out to receive vaccines, and they are all doing well,” Fatima says. 

Drop after drop, the team administers the oral polio vaccine to one child and then another, with the aim of protecting all the children in the shelter from polio. The disease can cause paralysis and even death if children are not vaccinated enough times. 

By the end of the day, the team had covered 180 children, including 29 infants aged under 12 months and some zero-dose children, who had never previously received any vaccines. Impressed by the numbers reached, Mahmoud shares that the change in behaviour among this community didn’t just happen overnight. It is the result of years of regular health education efforts by health promoters, health workers and volunteers.  

“We consistently engaged them through health education and awareness-raising sessions,” says Mahmoud, speaking of parents and caregivers. “We informed them that vaccination is a form of protection and provided examples of children from the community who did not receive vaccinations and how they suffered from diseases. As a result, they have become more accepting of vaccination.”  

This was also coupled with the engagement of community leaders, like the local mayor of Barqiq valley, who have since become advocates for child health, including vaccination drives. 

“These are our people and children, so we make every effort to include them in the health campaigns and routine immunizations,” says Mahmoud, a front-line hero for immunization efforts. 

In total, the 4-day Red Sea State campaign provided polio vaccine and vitamin A to more than 200 000 children aged under 5 years. Similar campaigns in 8 other high-risk states of Sudan will begin in late May 2024 to ensure that all vulnerable, accessible children are protected, no matter where they are. 

Background to GPEI efforts in Sudan

Amid the war in Sudan, Global Polio Eradication Initiative partners such as UNICEF and WHO have supported the country to prevent the further spread of its polio outbreak.  

 

UNICEF is procuring and delivering vaccines and leading social mobilization activities at the community level to increase uptake of vaccination services. It is also orienting key campaign stakeholders, such as social mobilizers, religious and community leaders and the media, on their roles.  

WHO has been technically supporting the development of microplans, the capacity-building of vaccinators, and intra- and post-campaign monitoring for vaccination campaigns. This is part of WHO’s ongoing efforts to support surveillance of poliovirus and the technical response to prevent its spread and boost children’s immunity, including through the rollout of polio vaccination campaigns.