Gates prioritizes children, women workers in $1.2B polio spending plan

The Bill & Melinda Gates Foundation will this year step up its efforts to try to rid the world of the poliovirus, the potentially debilitating disease that has evaded full eradication and has even recently resurfaced in some parts of the world where it was previously eliminated. The foundation is working with groups such as the World Health Organization and UNICEF to expand the distribution of the novel oral polio vaccine type 2 — nOPV2 —, which received WHO’s emergency use listing in 2020 and ended an outbreak in Tajikistan last year. The vaccine can help prevent the spread of polio variants that have emerged in under-immunized communities in the United States, Europe, and elsewhere. The Gates Foundation, one of the world’s wealthiest philanthropies, is among the top global health funders. Late last year it pledged $1.2 billion to support efforts to eradicate wild poliovirus in Pakistan and Afghanistan — the last two endemic countries. It also said it wants to fund efforts to help prevent the spread of new vaccine-derived variants of poliovirus, which is different from the naturally occurring wild polio and can infect an immunized person through environmental contamination, such as fecal matter. “To me, this is one of those decisive years for the polio eradication battle,” Ananda Bandyopadhyay, deputy director of the Gates Foundation's polio team, told Devex in an interview. “Disease eradication is a rarity. It doesn’t happen too often. In fact, we’ve only eradicated one human disease and that’s smallpox,” he added. The Gates Foundation is a partner of the Global Polio Eradication Initiative, or GPEI, which is funded by private and public donors, including Gavi, the Vaccine Alliance, UNICEF, and WHO. Gates has provided nearly $5 billion to GPEI. This year, GPEI is prioritizing outreach to communities with children who have never received a polio vaccine dose or who are considered under-immunized in outbreak-prone countries, or “consequential geographies” such as Yemen and Somalia. Devex sat down with Bandyopadhyay to discuss how the Gates Foundation is working with GPEI to implement a polio eradication strategy. This conversation has been edited for length and clarity. What are we in the global fight against the poliovirus? Where does the Gates Foundation think it can make a difference this year? I would say the virus is gasping, and it's not only the geographic shrinkage. We do very extensive genetic evaluations of how the different strains of poliovirus are looking. We do gene sequencing, and we can tell where the virus family is coming from, how many lineages there are of a particular type of polio. And believe it or not, as we speak today, there’s just one of each family in Pakistan and Afghanistan of that original type one wild virus. There used to be, even a couple of years ago, eight to nine to 11 genetic lineages of this same wild type one poliovirus. All these things are very strong predictors and indicators that the virus is on its way out. But as long as it still continues to find those critical masses of unvaccinated, under-vaccinated children, it will probably continue to survive. Global efforts to eradicate polio go back until at least the late 1980s. Not only has the virus not been eliminated, but now we’re seeing it resurface. Do you think it might be time to change the strategy? Two-thirds of polio has been eradicated. Wild type 2 has been certified eradicated. Wild type 3 polio has been certified eradicated. So we are left with wild type 1 and those sporadic vaccine-derived variants of polio that are there. There hasn't been one single strategy to eradicate. Of course, the bottom line strategy is to reach every kid with the vaccine. But how you do it, and with what kind of vaccines you do it, and what kind of detection tools are you applying to know if the outbreak is there or not there, how are you supporting the frontline health workers, how are you advocating with the political leaders and religious leaders, traditional influencers — all these components have evolved and constantly been adapted. About 15-18 years ago when we were only using trivalent oral polio vaccine, which has protections against all the three types of polioviruses, we saw that there are some pockets — India was one example, and there was Nigeria and other countries as well — where we thought we needed a vaccine that is more immunogenic against types 1 and 3, because by that time, type 2 wild was already gone. So rapidly, the program developed a bivalent oral polio vaccine and essentially took the type two component away. And then bivalent OPV became the first line of defense. The second bit of adaptation, innovation that has happened over time and time and again, is the field part of it. How do you strengthen and enable the frontline health workers, mostly women, to deliver the vaccines to the kids in the remotest of areas? In some areas you need a very strong participation of the local community and, again, I would underscore the role played by the local women, vaccinators, and mobilizers. Because to get to the household to start that conversation about that child who's going to be vaccinated, you need to connect with the mother. Some of the areas you and GPEI have identified as critical to efforts to increase immunizations and reduce transmission of polio are Afghanistan, Somalia, and Yemen. Many are dealing with conflicts, food insecurity, and other crises. What are the challenges of doing this work in those environments? These viruses are cruel. They don't wait and take turns. They attack children and populations of the vulnerable parts of the world. So, the polio program has all along, and more so in the recent past focused on an integrated approach. We also focus on what we call the “zero dose” children, who have not received any vaccines. As important as it is to get them the polio vaccine to not have that permanent paralysis, it's also equally important to get them the other life-saving vaccines. We do work with the country, regional, and the global partners so that some of these campaigns — some of these outreach activities to areas that might be inaccessible for a long period of time are synchronized and coordinated to the extent possible. And that also applies of late for surveillance. The sewage surveillance is an example where the United States detected polioviruses, in a way piggybacking on the COVID-19-related sewage samples that were collected. We have seen the other way around as well. In parts of Africa, COVID-19 surveillance is, in a way, mimicking how poliovirus surveillance was being done. Poliovirus surveillance infrastructure is very robust. We have more than 140 globally recognized polio laboratories. There were several examples as to how the polio emergency coordination centers were essentially used to mount the initial response to Ebola. Nigeria did that as a prime example. So to your point, knowing that diseases are not happening in isolation, these integration approaches are very much a focus. Do you see an opportunity to integrate the foundation’s polio program work with its gender equality work? We are applying the [diversity, equity, and inclusion] and gender lens in everything that we do, not only the program delivery and the vaccinators that I talked about — the frontline health workers, mostly women — but also research activities. This is something that I take a lot of pride in that we do talk about the frontline health workers, mostly women, and we should. But look at the scientists who are making defining changes in the polio world who are women and many times, women from areas and geographies that are not always well supported. Even in our grant-making process, including [research and development], we are trying to incorporate those lenses so that we not only identify such teams and ensure the work is supported, but also celebrate and bring them to focus and to talk about them.