Author: Ellyn Ogden, March 1 2016 [cross-posted from The Ethiopian Herald, linked below] - The work of a community vaccinator is vitally important, but rarely easy. Once, while working with an immunization team in Angola, my WHO [World Health Organization] counterpart turned to me and said, "Walk exactly in my footsteps to the village. There are landmines on either side of this path." Another time, after following a road in Nigeria as far as it would go, walking for another hour, traversing a ravine on a log bridge, a canoe river-crossing and a hike up a mountain, I arrived at a remote village where I was told, "Yes, the vaccination team was here, and all the children were immunized."

And in Ethiopia, the journey to polio eradication has been one of the longest and most encouraging that I have had the honor to participate in. I have seen firsthand the challenges that Ethiopia faced: a vast geography and remote areas, nomadic and pastoralist populations and some implementation gaps.

Gradually, under strong government leadership and with meticulous planning by partners, including strong technical and financial support from USAID [the United States Agency for International Development], each challenge was addressed and overcome. Each time I visited, things improved, and polio transmission was stopped not once, but four times after repeated virus re-importations.

Many of the lessons from polio eradication have now been mainstreamed by the government and are helping to fight other diseases. After nearly two decades of tireless efforts, the front line health workers deserve a standing ovation.

It is only fitting, then, that ministers from across Africa convened last week in Addis Ababa, Ethiopia, to establish support for immunization programs. I have worked towards polio eradication for nearly two decades, and continue to be inspired by Ethiopia's success.

Nineteen years ago USAID asked me to lead their global polio eradication effort. It was an exciting time.

The Americans had recently been certified polio-free. Progress in the Western Pacific and European regions was building momentum for the remaining WHO regions. In 1996, Congress had authorized [US]$20 million in funding for USAID to join the global effort.

Yet despite the excitement and global interest, there was also skepticism that polio could be eradicated in Africa, South East Asia and the Eastern Mediterranean. One of my first tasks was to evaluate the capacity in the field and see how best to use the new Congressional funds.

With my colleague Mary Harvey, a passionate and dedicated immunization expert in USAID's Africa Bureau, I went to Brazzaville to meet with the WHO/AFRO [Regional Office for Africa] team. This was on the heels of Africa's Regional Immunization meeting at which the continent pledged to stop at nothing to eradicate polio. Political will of African leaders was high: Nelson Mandela chaired the Kick Polio Out of Africa Committee, and planning had begun in earnest for National Immunization Days in over 40 countries. Enthusiasm and a can-do attitude were palpable, and we were welcomed with a sense of partnership and openness.

With our partners in Africa, we settled on the polio surveillance system as the primary activity for USAID support, including support for key regional staff. USAID's in-country missions expanded surveillance systems to detect and respond to suspected polio, supported an accredited laboratory network to provide essential data, and supported African regional and inter country technical staff, logisticians, and communication experts in countries planning and implementing immunization campaigns.

As the needs of the region came into sharper focus, we developed a program to engage civil society. The CORE Group Polio Program, still active today, has harnessed and amplified the engagement of international and local NGOs [non-governmental organisations] to reach mobile, migrant, cross-border and remote populations with polio vaccine and community-based surveillance in places where health services are few or non-existent.

USAID staff, myself included, participated in many polio immunization campaigns over the years. With a philosophy of doing everything we would ask of vaccinators, USAID staff spent countless hours in the field as independent observers and monitors. We participated in surveillance reviews, communication reviews and technical advisory group meetings.

With a solid grounding in field realities, USAID's voice in congratulating real success, identifying gaps, and challenging the status-quo has provided persistent yet supportive encouragement to solve the barriers to eradication.

We have approached political, traditional and community leaders and, when groups' fighting halted immunization campaigns in certain areas, negotiated for 'days of tranquility' to complete vaccination activities.

I have personally monitored dozens of polio campaigns and traveled across the continent to provide support for countries' immunization activities. I have seen firsthand the strength and resolve of my African counterparts. Many countries have eradicated polio despite poor economies, weak health systems, conflict and insecurity. Persistence, innovation, bravery and good humor are at the heart of success in polio eradication.

Now, as Africa is on the verge of polio eradication, I reflect back on how far we've all come. Unprecedented regional and cross-border coordination and collaboration have brought together governments, NGOs and community leaders in partnership towards a common goal.

There is still much to do before the world can be certified polio-free. Until there are no signs of polio transmission, not just zero cases, we cannot become complacent. Children are born every day who need routine immunization.

At the same time, it isn't too early to begin discussing how to transition the knowledge, functions, best practices and human resources to help countries achieve longer-term public health goals. USAID welcomes the opportunity to participate in the transition to the polio legacy.

It has been a great privilege to work with hundreds of polio workers, political and community leaders and the many USAID, UN [United Nations] and NGO staff who have participated in polio eradication efforts over the years. You are an inspiration, and you have my sincerest thanks and appreciation.

Click here to read the original blog in The Ethiopian Herald.

Photo caption/credit: Ellyn Ogden in Ethiopia checking on a little girl with polio. Photo provided by Ellyn Ogden Supportive Supervision in Ethiopia, 1999. Photo by Ellyn Ogden.

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