Since the announcement of the polio outbreak on 16 September 2019, WHO has been working with the Department of Health (DOH), and members of the Global Polio Eradication Initiative (GPEI) which includes UNICEF, Rotary International, the US Centers for Disease Control and Prevention (CDC), and the Bill & Melinda Gates Foundation to provide both technical and financial support on the planning and implementation of response activities.
These are the some of the activities that WHO and partners conducted in response to the outbreak.
1. Garnering high-level political support
WHO Representative to the Philippines Dr Rabindra Abeyasinghe and ASec Abdullah Dumama from DOH with other officials witness Davao del Sur Governor Douglas Cagas sign the executive order for all mayors in his province to support the polio immunization campaign. Photo: WHO/J. Orbina
WHO believes it is crucially important to engage high-level political figures, including governors and mayors from the affected areas to mount a successful polio outbreak response. Local authorities, community and religious leaders and media also played a critical role in ensuring the success of the immunization activities.
The Sabayang Patak Kontra Polio immunization rounds were done in October and November 2019 in Metro Manila and Mindanao. The latest round vaccinated 4.3 million children under 5 years, which is 99% of the target.
In Mindanao, Islamic religious leaders endorsed the campaign, convincing mothers with children from the targeted age group to vaccinate their children. The Philippine Paediatric Society also provided credibility to the vaccination campaign by highlighting vaccine safety and efficacy. Every extra dose provides the child with additional protection against polio.
2. Stemming outbreak risks and spread
Dr Achyut Shrestha, WHO Medical Officer, monitors a vaccination team during one of the polio campaign rounds in Manila. Photo: WHO
At every round of planned vaccination activity, WHO and partners worked with the DOH to support microplanning activities, determine the coverage from each barangay, the availability of vaccines, and cold chain logistic planning to ensure that vaccine efficacy will not be compromised.
Health workers provided polio drops at fixed and outreach posts including hospitals, barangays, nursery, and primary schools, and in high traffic areas like markets, bus stations, and other public areas. They also went house-to-house to identify and vaccinate missed children.
3. Providing enhanced surveillance activities
Briefing for STOP members by Keith Feldon, the outbreak WHO outbreak response coordinator. Photo: WHO/I. Tan
The surveillance activities were two-pronged, contact tracing of confirmed polio cases to “connect the dots” in these high-risk provinces, by observing and monitoring population movements, with the goal of preventing further spread.
Surveillance teams are working on identification of acute flaccid paralysis (AFP) cases, and detection of polioviruses through collection and testing of environmental samples from waterways and sewage, and to establish link with polio cases.
DOH selected sentinel sites, hospitals, and health facilities to support the AFP surveillance. All health facilities were mandated to promptly report every case of AFP in any child under 15 years of age, and collect sufficient stool specimen samples. AFP surveillance was also complemented with community surveillance when possible, to collect information on patients with floppy limbs and other polio symptoms.
To support the enhanced surveillance activities, WHO worked with US CDC on the deployment of Stop Transmission of Polio (STOP) members to be based in provinces, to enhance local surveillance capacity. The strengthened surveillance activities resulted in the identification of four new cases of polio, bringing the total number to 16, which included the first polio case from Metro Manila. As of 21 January 2020, DOH has detected polioviruses in a total of 33 positive environmental samples.
4. Advocacy, social mobilization and risk communications
Dr Xiaojun Wang, Expanded Programme on Immunization Team Leader at WHO Philippines, emphasizes at the Davao City partners’ meeting the need for collaboration in addressing the polio outbreak.Photo: WHO/J. Orbina
WHO supported the advocacy and social mobilization activities led by UNICEF, using a ‘whole-of-community’ approach in ensuring each child receives the polio drops in every campaign round. The strategies were developed based on existing evidence of social perceptions, norms and beliefs of local communities, and their understanding of polio.
A rapid convenience assessment was completed after each round of campaign to check if the community understood the polio messages. In terms of social mobilization, local authorities, religious leaders, and health workers, played an important role in explaining and convincing mothers to participate in the campaign and vaccinate their children.
The capacity of the health workers was strengthened with training on polio service delivery, and additional training will be conducted to increase their knowledge on polio, its risk to children, and the benefits of vaccination.
The way forward
As new cases continue to be detected and reported, WHO will continue to support the DOH on ground technical support for immunization activities, surveillance, advocacy, and risk communication.
WHO will work with DOH to explore the possibility of using the additional rounds of the vaccination campaign to deliver routine immunization vaccines to eligible children and strengthen the routine immunization program. Enhanced surveillance will continue, through hospitals and sentinel sites, with plans for community surveillance.