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by Bekele Geleta
Breaking community barriers to achieve Polio eradication is vital
Never before has the world been so close to eradicating polio, a terrible disease that can paralyze a person for a lifetime. Today, the disease only exists in a few reservoirs around the world.
The poliovirus is obstinately entrenched in pockets of Afghanistan, Nigeria and Pakistan, where we are confronted by complexities such as conflict and insecurity, parents and caregivers refusing the vaccine for their children and logistical challenges. Sadly vaccination workers are increasingly the subject of attacks, as evidenced in recent events in Nigeria and Pakistan.
These factors fuel a frustrating situation where many children don’t receive the polio vaccines they need, and where there is a heightened risk of the disease spreading across borders and crippling more children.
Yet, polio has been beaten down to its lowest levels ever, and we now have a unique, time-limited opportunity to end the disease once and for all. I am inspired by the leadership, generosity and commitment of Bill and Melinda Gates who have made the eradication of polio a very personal mission. I am also struck by the support of national government leaders across the world and the 20 million volunteers who have committed to the mission that no child should ever be crippled by this terrible disease. We must mobilize all stakeholders - from local communities to global leadership to help eliminate the barriers that stand in the way of eradication.
I have seen first-hand the ravages of polio. Growing up in the small village of Nedjo, Ethiopia, my best friend had polio and I used to help him carry his school books. I admired his fortitude, but I recollect vividly the pain he experienced growing up, unable to walk unaided and disabled for his entire life.
While the challenges we face in the last polio reservoirs are difficult, they are not intractable. To end polio forever, we must answer a critical question: what is the missing ingredient for reaching the most remote and isolated populations? What will it take to finish the last mile?
I believe the answer is two-fold: community led engagement and greater access. This is where the Red Cross Red Crescent can join forces with champions of the cause such as the Bill & Melinda Gates Foundation, UNICEF, WHO, GAVI, Rotary International and others to cross the line.
In high-risk communities, many children do not receive polio vaccines because of misconceptions and distrust of the disease’s cause and the vaccine’s safety. Trained volunteers, who live in the same community as the local population and speak the same language, can help reach the most inaccessible, poor and marginalized communities. Volunteers, such as those of the national Red Cross and Red Crescent Societies, can help promote vaccination and other maternal, newborn and child health interventions. This would ensure that the polio immunization initiative is perceived to deliver broader health services rather than being seen as a one-off vertical intervention.
Volunteers are also a trusted source of information to help dispel myths. This has been proven in the Democratic Republic of Congo, where local Red Cross volunteers helped counter perceptions that polio vaccines were poisonous, which ultimately averted a potentially disastrous outbreak.
In Afghanistan, which has poor infrastructure, insecurity, extreme poverty, high illiteracy and gender inequalities, Red Crescent health clinics and mobile health teams have learned that putting women at the centre of their maternal and child health interventions is critical. They develop women’s confidence and recognition within their communities. Trained female volunteers in the most remote areas have contributed to vaccinating almost 250,000 children over the past ten months, using culturally-sensitive approaches that address gender-specific barriers and encourage women to regularly seek health care. These lessons will inform polio eradication efforts in Southern Afghanistan, one of the regions at highest risk for the disease.
Another major challenge is that polio is still not perceived as a major public health threat in many communities of endemic countries. Malaria, measles, diarrhoea diseases, lower respiratory tract infections and malnutrition still represent the major causes of child death in those countries.
And so we need to bring a combination of services to people’s door steps to bridge the health divide for people with little or no access to health care and information and we need to integrate polio vaccination in those approaches. We need to focus on access and find innovative and culturally sensitive approaches to achieve it.
We need also to address the issue on a rights basis. Red Cross volunteers can provide their communities with the knowledge and resources to demand their right to vaccination and take up available resources, to influence their governments and health ministries.
In a recent speech, Bill Gates drew similarities between the pace of innovation and the journey towards eradication of polio. In the 70’s we had a dream of giving everyone access to computer technology and now, he said, there is “a computer in every pocket”.
As computer product marketers know, breaking down barriers to greater access – such as price, availability, usability– is vital to conquering a market.
This is also the key to polio eradication. Breaking down barriers to allow greater access for the most isolated and marginalized populations is essential to conquering the beast that I truly believe we will one day look back on as pol
Bekele Geleta is the Secretary General of the International Federation of the Red Cross and Red Crescent Societies.