Polio – a dreaded disease
In the 1900s, polio is one of the most feared childhood diseases in industrialized nations, without a cure.
Regular polio epidemics are happening in North America and Europe.
Polio is thought to only affect industrialized countries and is not considered a ‘tropical disease.’
Yet by 1950, there is growing recognition that polio is also affecting the ‘developing’ world.
A huge polio outbreak in the U.S. paralyses 27,000 and kills 6,000, activating a surge of research.
The first polio epidemic is recognized in South Africa after soldiers return from the Middle East after the First World War.
The ‘iron lung’ – an artificial respirator that helps paralysed polio patients breathe – becomes widely used in Europe and the U.S.
South Africa’s largest polio outbreak with 3,000 cases and 200 deaths catalyses a major fundraising campaign. Africa’s first foundation for poliomyelitis research, the Poliomyelitis Research Foundation opens in 1950.
© Poliomyelitis Research Foundation (PRF)
Large polio epidemics are seen in Angola, Democratic Republic of Congo (DRC) (then known as Belgian Congo), French Equatorial Africa, Kenya, Zimbabwe (then known as Rhodesia), Uganda and South Africa.
Polio vaccines bring hope
By the 1950s, an estimated 600,000 people are paralysed each year around the world.
The development and widespread rollout of the polio vaccine across industrialized countries leads to a steep drop in polio incidence.
Polio cases in Africa are increasing. In 1955, Dr James Gear, director of South Africa’s Poliomyelitis Research Foundation says, “It is clear that the disease is endemic in all the countries of Africa.”
Algeria is hit by multiple polio outbreaks related to mass displacement caused by the War of Liberation. The Algiers Hospital of Infectious Diseases establishes a polio service in 1955.
© Prevention Department of Algerian Health Ministry
In Africa, 18 countries report polio cases to the WHO, which sets up a Global Expert Committee on polio and designates a network of WHO regional polio laboratories.
Dr Jonas Salk develops the first polio vaccine, an injectable vaccine called the ‘inactivated polio vaccine’ (IPV), which is tested with over one million children in the U.S. in 1955.
Dr Albert Sabin develops the oral polio vaccine (OPV), which is used in mass vaccination campaigns in the U.S. in 1961.
WHO recommends the use of OPV in field trials during a meeting attended by the world’s top polio specialists.
Polio cases increase in 24 of the 34 African countries with recorded polio cases, according to WHO and other reports.
OPV becomes the ‘vaccine of choice’ for most of the world, because it stops person-to-person transmission, and is easier and less expensive to administer than the injectable vaccine.
Polio in the developing world
By the mid-1970s, only a few African countries have immunization activities.
Routine immunization, including the polio vaccine, is introduced globally, but many people are still not reached with the polio vaccine.
168,000 cases of polio are estimated to occur in Africa each year – much higher than originally suspected. This data is based on ‘lameness surveys’ conducted in 14 African countries, starting with Ghana.
The Expanded Programme of Immunization (EPI) is established to bring vaccines to the world’s children.
In South Africa, the Poliomyelitis Research Foundation Laboratories open, which later becomes the National Institute for Virology.
© Poliomyelitis Research Foundation (PRF)
The U.S. is officially wild polio-free after extensive nation-wide vaccination campaigns.
Global commitment to eradicating polio
Success against polio in the U.S. and other developed countries inspires the idea of global polio eradication.
By the late 80s, most African countries are immunizing children against polio as part of routine immunization.
Rotary International launches ‘Polio Plus’, a 20-year commitment to raise funds to protect all children from polio. Rotary chapters around the world begin fundraising.
The World Health Assembly endorses a resolution to eradicate polio worldwide by the year 2000. The ‘Global Polio Eradication Initiative’ (GPEI) is launched – one of the largest public health initiatives in world history.
The WHO Regional Committee for Africa adopts the 1988 World Health Assembly resolution and endorses the goal to eradicate polio from the continent.
The African region commits to eradicating polio
With an estimated 75,000 children paralysed by polio each year, African countries commit to eradicating polio and start implementing eradication strategies in earnest.
The GPEI makes huge investments in training, immunization infrastructure and equipment, disease surveillance, data management and high-level coordination across Africa.
The infrastructure developed to fight polio starts being used to support other disease efforts on the continent.
Organization of African Unity (OAU) leaders adopt the Yaoundé Declaration to eradicate polio in Africa. Nelson Mandela launches the influential ‘Kick Polio out of Africa’ campaign with Rotary International, which is supported by heads of state, African celebrities, football players and philanthropists.
© Courtesy of Rotary International, with permission from the Nelson Mandela Foundation
Cameroon, Cote d’Ivoire, Kenya, Tanzania and Uganda conduct the first national immunization days specifically for polio in the African region. By 2000, nearly 30 African countries launch national immunization days.
© Sam Okiror
The Africa Regional Certification Commission (ARCC) for Polio Eradication is appointed to independently oversee certification and containment of polio in all 47 Member State countries.
After large disease outbreaks in West Africa, polio funds and staff are used to scale up surveillance of other communicable diseases, through the Integrated Disease Surveillance Response (IDSR) strategy. Thousands of polio surveillance officers are trained to monitor up to nine other diseases.
The last wild poliovirus type 2 case is reported in the African region in Nigeria.
The first house-to-house polio campaigns in the African region are conducted in Nigeria, reaching 40% more children than routine immunization, making this an essential strategy for polio eradication.
The UN Secretary General Kofi Annan negotiates the first ceasefire agreement between warring parties in DRC to allow ten million children under five years to be immunized against polio over a three month period.
A huge outbreak of polio type 3 occurs in Luanda, Angola after 800,000 displaced people fleeing conflict in DRC seek refuge. A million children under five are vaccinated.
One step forward, two steps back
The number of annual wild poliovirus cases has dropped to under 1,000 worldwide, thanks to mass polio vaccination campaigns.
Almost the whole of eastern and southern Africa stops the transmission of indigenous wild polio. The wild poliovirus is now endemic in just Nigeria and Niger.
There is huge optimism that polio can be eradicated in Africa, but the polio programme faces major challenges. Repeat outbreaks in Nigeria and imported cases in Angola affect other African countries.
24 countries are declared wild polio-free.
The first multi-country synchronized campaigns in western and central Africa take place across 17 countries. Tens of thousands of volunteers vaccinate more than 76 million children.
The first case of circulating vaccine-derived polio (cVPDV) type 1 is detected in Madagascar, where the last wild polio case was reported in October 1997.
A boycott of the polio vaccine in Northern Nigeria over vaccine safety concerns leads to a polio outbreak that spreads to 20 countries by 2008. In response, Africa mounts a vast multi-country synchronised campaign across 23 countries, reaching 80 million children under five years.
An outbreak of wild polio is declared in the Horn of Africa and Yemen, with over 700 cases. Emergency immunization campaigns across eight countries, including Ethiopia and Kenya, reach more than 34 million children.
Importations of wild polio type 1 from India cause outbreaks in Luanda, Angola with further importations in the country in 2008 and 2009 and cross-border spread to Namibia in 2006. Immunization campaigns are mounted in response.
© Namibia Ministry of Health
After being wild polio-free since 2004, 54 cases of wild poliovirus type 1 are reported across four provinces in DRC.
In Nigeria, Immunization ‘Plus’ days engage local communities offering ‘add ons’ including other health services and basic goods.
The World Health Assembly calls on Nigeria to respond swiftly to a polio outbreak that affects 15 countries in western and central Africa by 2010. Synchronized cross-border vaccination campaigns are conducted across the region. Over 400,000 volunteers and health workers immunize 85 million children.
© Adeniyi-Jones Jidef
When the global economic crisis affects health funding in Africa, polio data management teams fill the gap for malaria and HIV/AIDS data management.
The final stretch
The final march toward certification is marked by huge setbacks as well as the introduction of many innovative strategies and technologies.
A decline in population immunity levels in many African countries puts communities at risk of polio outbreaks.
After Nigeria was taken off the endemic list in 2015, new cases of wild poliovirus are detected in insecure Borno state in 2016. A vast nationwide effort helps Nigeria stamp out the wild poliovirus once and for all.
23 countries are declared wild polio-free.
On 25 August 2020, the WHO African Region becomes the fifth WHO region to have eradicated wild polioviruses.
Despite this incredible public health achievement, the fight against poliovirus is not over. More than a dozen countries in Africa remain affected by cVDPVs.
The GPEI and governments recommit to reaching every child with polio vaccines.
Environmental surveillance for poliovirus is used for the first time in Nigeria and expanded to over 300 sites in 26 countries in the African region.
© Andrew Esiebo/WHO
Nigeria sets up an Emergency Operations Centre and launches a national emergency plan, which propels progress. At this point, Nigeria accounts for 50% of the world’s wild polio cases.
© Bill & Melinda Gates Foundation
The last wild poliovirus of type 3 case is reported in the African region in Nigeria.
After an outbreak of wild poliovirus type 1 in Somalia spreads to Ethiopia and Kenya, large-scale vaccination campaigns are mounted across Horn of Africa countries.
The WHO declares wild polio and cVPDVs as a Public Health Emergency of International Concern (PHEIC), spurring an international response.
Polio infrastructure and technology are used to conduct Ebola case finding and contact tracing in Nigeria.
After almost three years without a case, four cases of wild poliovirus type 1 are detected in northern Nigeria around Lake Chad, following the disruption of polio vaccine campaigns due to an armed group. A vast multi-country Lake Chad emergency response targets over 45 million children in Nigeria, Niger, Cameroon, Chad and Central African Republic. Nigeria returns to the list of polio endemic countries.
© UN Foundation/Christine McNab
An external review of eight African countries finds that the polio programme has provided major benefits to Africa’s health systems, including for disease surveillance, routine immunization and outbreak response.
© Rotary International
155 countries and territories, including across Africa switch the ‘trivalent’ OPV with the ‘bivalent’ OPV, which does not contain the eradicated type 2 strain.
The DRC sees a wave of cVDPV outbreaks that leave 29 children paralysed. A national public health emergency is declared.
There is an increase in reported cVDPV cases across all regions in Africa. Cases are reported in 12 countries with low levels of routine and supplementary vaccination coverage.
© GPEI RRT
The WHO’s Regional Office for Africa sets up a Rapid Response Team to coordinate responses to cVDPV outbreaks.
© GPEI RRT
Nigeria celebrates three years since its last wild polio case, which kickstarts the process for certifying the African region free of wild poliovirus.
© Andrew Esiebo
The ARCC certifies the WHO African Region as polio-free after passing more than four years without wild polio detected by certification-standard disease surveillance.