Well polio be eradicated worldwide the World Health Organization declares a major victory against the virus in africa but its still crippling children in afghanistan and pakistan all the lessons to be learned in the battle to control the coronavirus pandemic this isnt. Hello welcome to the program i mean wrong polio used to paralyze and disfigured tens of thousands of children every year and some didnt survive but major strides have been made in eradicating the disease much of the world is now polio free including africa the continents last case of naturally occurring polio was reported in Northern Nigeria 4 years ago but the campaign in borno state to immunize every child was attacked by boko haram fighters who killed an abducted Health Workers some children can still be struck by a red phone a polio virus it mutates from the polio vaccine and can then cause an outbreak in communities which havent been immunized. Lets have a look at the global fight against polio the disease was common until the vaccine was discovered in 1952 but it wasnt until 988 that a Global Initiative to eradicate polio was launched 30 years later reported infections decreased from 3500082 just 33 and while theres been success in africa naturally occurring polio virus is still spreading in afghanistan and pakistan with 87 cases reported this year called haida reports from islamabad. Situated on the outskirts of islamabad no 48. 00 advocation of the polio widest hair in pakistan just of runneth on and pakistan are now the 2 remaining countries pakistans battered it began in the mid 99. 00 however pakistan has suffered many. Including the alpha one wall and up low back a fake also the fact that protestants driver larry along the of onboard what carter all for many because of the conflict there the program said back in 2011 after a fake cia led program. To take a thumb up in law didnt read about their gave an excuse to come of the Group Fighting against the government or start targeting wreck the nation doesnt have been lucys communicate because of this. Pull you into Education Campaign these are the sensitive a. D. R. s and there is a boss tasty offer on the attacks and these are. The Security Forces so as a precaution that he may as well throw away things you could conclude these people are like not just on is how is unless you decide we have successfully conducted this campaign my crossed my know what some people are against this campaign but they had been censured and now i think this challenge has been diminished has been contained the large extent this is one of the more operations in the word and wall ring games of powder. Having Large Scale Campaign which go was 130 districts in pakistan in this particular campaign we started getting about 34000000 under 5 children the plan that we have. We. Say that in 20 twentieths of consolidating the transformation the face of the start and in charlotte the big 2021 as the year of interruption in pakistan. Where did imported to the north there while pakistan was making progress till march 19th friend demick was another setback raising fears of another spike. Lets bring in our panel in atlanta in the u. S. Talk to hama joffrey director of polio eradication at the World Health Organizations Eastern Mediterranean region in lancaster in Northern England there gather their largest and lecturer at Lancaster University and in the philippine capital manila Susan Macarthur strategic adviser for the International Federation of the red cross and red crescent societies in asia pacific welcome to you all id like to begin atlanta with dr Howard Geoffrey firstly it is a point of congratulations that you might say eradicate polio in africa certainly a very big job but tell us what were the challenges in particular within africa and what would what was the real turning point for you that you knew that you could be able to eradicate the disease 1st of all really a massive congratulations d to africa it has been a tremendous and enormous effort in the countries and the government and the g. P. I. Partners have put in that continent which is led to this amazing achievement of course what it means for africa that at least the threat within the continent of wild boar your voters of all 3 types is eliminated and hopefully forever that threat of course really means to some extent as long as there is one pull you out anywhere which is right now as you said is now only in pakistan and afghanistan but i think this is it is extremely important milestone not only for what it means for africa but also what it means for the Eastern Mediterranean region particularly the 2 remaining endemic countries of pakistan and afghanistan of course the the pressure as it were will go up on these 2 remaining endemic countries. To really meet these final challenges of it education in pakistan and afghanistan but it also instills enormous confidence in the Overall Program because of the kinds of challenges that existed in nigeria that have been overcome both it been years of enormous social rejection population due to misconceptions around the polio vaccine and pull your program rejecting the program attacks on Health Workers and then a massive conflict Armed Conflict and civil unrest particularly in northeastern nigeria which the program with the commitment of the government and partners has been able to overcome and that instills a great deal of confidence for what is possible and achievable in pakistan and afghanistan well lets talk about pakistan and afghanistan dont have a jeffrey what were really looking at here is a failure of politics and political will in pakistan or afghanistan or are we talking to countries that are simply too big too complicated too well to remote so actually administer in effect have eradication program. Well you know its important to put all of this in context when we were struggling to educate polio in india there were many voices that said given the size of the country the social complexities and then we also faced that injection by certain minority groups of the polio vaccine they had again after the success it was demonstrated that it is biologically and technically feasible to do that a gate polio from the guts of more than 1100000000 people in a country so that in terms of the size and true appropriate Community Engagement strategies becoming one when those communities you can actually a partner with them and overcome these social challenges the united your program is in some ways short using the same success now that you know afghanistan the major challenge from for the program is right now access to children that live in the areas that are controlled by the taliban where the polio vaccination is is banned in nigeria have similar challenges and problems of excess in parts of nigeria northeastern part of the country and important lessons have been learned there on how in the setting of limited access still vaccines can be delivered for there is really it creates a lot of optimism in the program that the learnings that happening from these large complex countries in pakistan the major issue right now is not the lack of political commitment that is substantial political commitment but what is needed is to again engage and build bridges with these communities who are rejecting interest in pockets of pakistan that are rejecting. Vaccination and a lot of what is needed to listen to these communities involve d the Community Members and Community Leaders in the delivery of the program more systematically and clearly the what we have seen in the context of 19 both pakistan and have done is. Theres been a true all of government mobilization all of society mobilization to counter the covert 1000 pandemic and we are learning lessons from that as do we as all your Education Campaigns mass vaccination campaigns are being resumed now in the setting of the covert that work lessons can be learned from this intense political mobilisation in pakistan and how the political and administrators set up and really up its game from the lessons that have been learned in the Government Team to sponsor working with all your programs so that that same National Momentum can be applied to all United Nations i will get to my guests and lancaster and manila in just a short while but one more question to you dr hama jeffery pakistan in particular was set back by the Central Intelligence agency and that program of using a polio vaccination work to in the search for Osama Bin Laden people in pakistan after that when they found out simply didnt trust polio vaccination workers the program and they said it was it all for us imperialism i mean how would how how much did that set pakistan back. You know even soon after that happened importance of river done by one of our Partner Agencies unicef and so the most affected areas around the time when actually vaccination was banned in the area of North Waziristan at that time under the control of the taliban element in even sort of a zone at that time family said that if a 95 percent of the families said that if vaccinate comes to our door to vaccinate a child we will not reject we will accept the vaccine so it should it is important to realize that the vast vast majority of families in pakistan are accepting the vaccine when it is delivered to them they are very rare circumscribed pocket in parts of the shower suddenly have a phone call parts of kentucky parts of the poor into baluchistan area well defined areas where there is still misconception around the vaccine and i think what recently has happened is a bigger challenge is actually a lot of the social media that has sort of cornflakes and been the antivaccination movement and a lot of the social media material is being bombarded in pakistan to these communities who have had doubts about the program and there doubt dont come to dont come from something that happened you know nearly 10 years ago these these doubts come from because these communities are living in areas where there are very limited essential health and Civic Services and the only service that comes to their doorstep is the polio vaccine and that creates in this connect of trust and thats where the program is now looking to address about how we can integrate delivery of essential services along with polio vaccination in these communities well lets go to Susan Macarthur in manila this disconnect of trust is something that is not just when it faces. Any not just the Podium Program but any Vaccination Program people do seem to be suspicious about particularly within Rural Communities whats your experience of that well in general in the philippines people have been used to the Immunization Program although in some indigenous groups its not accept that one might because the well your got the nishant has is being given through drops then its less threatening so i would say that people dont need to resist now there are a gather air in lancaster youre a very largest and an elector on these things how much of this kind of global and he vaccination. Seems to be spreading if i just look at my social media i am seeing people criticize every single Vaccination Program and it seems to be getting more and more popular the science seems to be losing. Well we know that vaccine his in c. S. Is spreading in many places and we dont really know what the flu reasons are for a vaccine his did see many studies have been done that have attempted to dissect the reasons that people have for refusing vaccines and it seems like as if sometimes when people are on the fringes of society frequently there are people that court extreme political views of of various kinds but with extreme right wing political views and extreme left wing political views frequently there are people that belong to minority religious groups that may have certain rules about their conduct and certain medical procedures that are low and also we find that both very poor people and very rich people tend to be more vaccine haste people in the middle so its really difficult to to tease the reasons why vaccine has its use growing because it isnt a single group of people in society that are moving into this mindset it seems to be of a wide variety of people. With in many cases with completely different social circumstances in completely different Belief Systems but theyre latching on to this idea that vaccines are not good for their children so theres clearly a lot a lot of important work to be done on the psychology of vaccine has its it and also play planning hoho we can best get that message across so its on the card and the next biggest challenge is going to be the delivery when eventually arrives of the coronavirus that saying into remote areas is there anything that you may have learned from the Polio Eradication Program that prepares you for something that will be a mass event in the world. Well the experience in the Red Cross Movement is that once you engage Community Leaders and you get the Community Involved in a mining Vaccination Program then youre bound to be more successful in weve seen that in you know supplementary immunization projects that happened within the ambit of Red Cross Society so preparation really involves not grassroots localized leadership of individuals who understand how to communicate and how to mobilize mothers to bring their children for vaccination the same will be true for we will only be successful with it who with vaccination if we are able to properly in gauge with whom there are gather a part of the polio vaccine is one thing you were able to get lots of people in to a large space you were able to in a pope give them the polio vaccination with coronavirus were going to have to socially distance or theres going to be a Real Security and practical challenges in trying to deliver a the virus sorry the vaccine when it comes and to try and stop the virus from spreading when that many people are gathered together all their unique challenges then with covert 19. 19 to already causing problems with many medical not normal medical it to fit is we know here in the u. K. That hospital appointments for various long term conditions have have gone down there have been reports of people having been receiving Cancer Treatment and saw in a fight as vaccination is concerned also that the poor Vaccination Program has been a fair effect this year the World Health Organization have said that both to the monitoring for cases so that this is done by looking for cases of paralysis in children so thats the monitoring part and then theres also are a more population surveillance part which involves testing sewage and fi core samples for traces of the virus to see whether the virus is circulating in in a Community Support these clinical surveillance and Laboratory Surveillance activities that are connected to more knitting where poorly or might might be spreading and have been impacted by coffee 1900 theyre simply not happening at the labels that the they need to so yes its possible that that cough cough 1000 might through a spinal in a worksheet of our ongoing efforts to to completely eradicate wild poor fighters type one in india and pakistan and indeed to prevent it from coming back to to other parts of the board like africa its important i think to emphasize that even even if we do get to eradication in the last year we had 175. 00 cases confirmed cases of polio in the entire world and that thats thats dont from hundreds of thousands about 3 decades ago says it enormously successful but nevertheless were going to have to keep vaccinating people because theres always a possibility as long as that at some point we will circulating that it will find its way into susceptible population once you stop vaccinating you have. Your children being born in it theyre coming in and theyre not not immune and they herd immunity that level. Will be dropped so that the proportion of people in the population that are that to remain will come down and eventually will reach a level where were poor who if it can find a sceptical population will start to break out again so its really important that we keep on vaccinating for some years no to make sure that not all the poor is gone and everybody its much needed until that time rights so that the nation has to be the new normal there jeffrey all their lessons to be learnt case studies anything because we are a way a long way away from a coven 19 vaccine but in terms of how you operate in africa how you operate in the rest of the world are there lessons to be learned for when eventually and right now dealing with kovan one thing. You see the kind of fear and panic we have seen now with go over 19 the same kind of bendigo existed in the u. S. And around the world when these outbreaks of all your what happening and there was no exene and a vaccine was developed and massive trials were conducted and then there was vaccination done it had changed obviously the whole face off and the threat of polio. But weve also learned both from polio and we even learned this with all of the vaccines and the covered vaccine that direction is no good if it keeps getting in the vile it has to be delivered to the most Vulnerable People and i think the history of for your education as my colleague was just mentioning is that weve come from you know hundreds of thousands of cases each year to less than a couple of 100 pull your virus cases is because of the success of the vaccine and i think we have learned very important lessons as to how to deliver those vaccines in the most difficult areas or we have that is lack of trust and the kind of challenges that the well your program has been faced with and is consistently successful in overcoming and thats by todays news is so important of africa becoming well youre free none of the problems youre seeing in a van a son in pakistan are some things that we have not seen in nigeria or other parts of the parts of the world obviously the solutions are unique but we have the confidence to to overcome them i also wanted to make a couple of comments on your question about the impact of over 19 on the poor your Education Program and i think already mentioned that it has affected surveillance for polio virus and we are now working to fruit of restore that surveillance a lot of our whole your workforce infrastructure assets were immediately repurposed for the response to the over 19 for the what you would Education Workforce and infrastructure of highly trained in surveillance Disease Detection in organizing communities communication Data ManagementEmergency Management have been all involved in the cove in 1000 response but as of july many of the countries particularly including pakistan and afghanistan did resume their mass vaccination campaigns with very important precautions so that for example only including workers who are from the local community so that they dont bring infection from outside into a community that may not have over 19. Everyone to are screened for symptoms and fever of over 19 they were given each worker was given professional protective story dr jeffrey we we are running out of time and i would like to get to some of the other guests as well. You heard there about the idea that the you know the infrastructure was used to deal with covert 19 but you were a Strategic Advisor underpinning all of this is funding money covert 19 as provided you with an immense challenge. Is there enough money and enough will to keep a Covert Program up up until we get a vaccine i think thats going to be very challenging i mean. Could be does he have both the developed and the developing countries in the nursery usually have enough to give to the developing world now are going to be holding on to their own resources whether those are vaccines or Human Resources for their own needs so i think we are really up against a huge challenge in terms of bringing the vaccine to the most vulnerable in in the fastest quickest possible way so i do believe that you know financial and other resources. Going to make it very difficult for poor countries to get the vaccine and to use it effectively does have a jeff or just very quickly of the w. H. O. Has a funding challenge it is if not running out of money then it will run out of money at some point in the next 12 months when it comes to if there is another outbreak of covert 19 with what he going to do about that. So i mean i think this really highlights the so far extreme underfunding in Public Health care passage a development in dealing with emergencies in countries around the world for the Polio Program obviously view for taken a setback as the writer said expanded during the time when the vaccination campaigns were suspended so the cost of the Polar Program has gone up but i think the covert 19. 00 brings an opportunity also of better integration clearly Public Health is now at the center of the economic debate as well and we are optimistic that discovered by endemic finally will bring an opportunity maybe d they will be sufficient investment in basic Public HealthHealth Service delivery and also the programs that can leverage the poor education infrastructure of the vaccine delivery mechanism to provide more integrated services and for that you would have multiple streams of funding supporting integrated programs i want to thank all our guests homage offered tara gather and susanne mercado and thank you to forging you can see the program again any time by visiting our website out is there until come and for further discussion go to office book pays at facebook dot com forward slash a. J. Inside story i knew can also join the conversation on twitter we are at a. J. Inside story from am wrong and the whole team here by the no. The health of humanity is at stake a Global Pandemic requires a global response. W. H. O. Is the guardian of Global Health delivering lifesaving to lose supplies and training to help the worlds most Vulnerable People uniting across borders to speed up the development of test treatments and of that seat keeping you up to date with whats happening on the ground in the ward and in the lab now more than ever the world needs w. H. O. Making healthy a world for you. To everyone. 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