Q&A: Addressing polio through a gender lens

“Look at women's needs holistically and then program around them.” That’s the advice of Ambassador Lana Zaki Nusseibeh of the United Arab Emirates Permanent Mission to the United Nations when it comes to eradicating polio. 

While the UAE — alongside the majority of countries — has been polio-free since 1991, Pakistan and Afghanistan are yet to eradicate it. As long as the infectious viral disease still circulates, there’s always a threat it could spread to other countries and among unimmunized communities. There is no cure for polio — which mainly affects children under 5 years of age — but a vaccine, given multiple times, offers protection.

“Polio is not just about immunization,” Nusseibeh said. “It is a manifestation of needs related to water and sanitation, education, roads, clinic access, among many other things. The more we can combine these services by design, rather than by accident, the greater dividends we will see for women and girls.”

The integration of the Emirates Polio Campaign into the UAE’s broader Pakistan Assistance Program, which provides school and health care access, is an example of this in action, she added.

Speaking to Devex, Nusseibeh explained more about the UAE’s efforts to rid the world of polio, why a gender lens is crucial, and the lessons to be learned from COVID-19.

This conversation has been edited for length and clarity.

Can you explain more about the UAE’s commitment to polio and the actions it's taken to eradicate it?

The UAE and, in particular, His Highness Sheikh Mohammed bin Zayed Al Nahyan — the man who's been the driving force on this — has been aiming to eliminate polio globally for the same reason as we did it at home. It's a disease that not only damages individuals and families but also handicaps broader development and economic growth.

Systems cannot function when people are falling sick or scared of getting sick — as we've seen with COVID-19 — and so we were really honored to host the Reaching the Last Mile Forum last year, which raised $2.8 billion for polio eradication and also framed polio as more than a health issue, [but] an outcropping of water and sanitation, education, health care, and gender equality challenges as well.

Sheikh Mohammed bin Zayed has focused on support to the Global Polio Eradication Initiative, a partnership with the World Health Organization, UNICEF, the Bill & Melinda Gates Foundation, the Centers for Disease Control and Prevention, Rotary International, and more recently Gavi. He contributes to the initiative, especially through the Emirates Polio Campaign in Pakistan.

What do you think it will take to eradicate wild poliovirus?

Cases have dropped 99% since 1988, with the two remaining countries, Afghanistan and Pakistan, showing marked progress since then, too. So we're tantalizingly close to eradicating a disease for only the second time in history after smallpox. I think continued commitment to the objective, despite COVID-19, is going to be key here. UNICEF and the WHO estimate that the failure to eradicate polio now would lead to a global resurgence of the disease, resulting in as many as 200,000 new cases annually.

Pakistan has unfortunately seen a spike of cases in the last year, with 82 cases thus far in 2020 and 147 cases in 2019 so more than the last four years combined. The immunization campaigns need to continue and they need to be gender-responsive. I think that's our best shot for eradicating it entirely.

What role do you think gender plays in health-seeking behaviors and health outcomes generally?

Without a gender lens, you will see this divergence in outcomes between men and women and boys and girls. The result, including in health, is for women and their children to have lower life outcomes and for the economy to suffer. So there's both a moral and business case for tackling that divergence. And that's really why the UAE has made gender one of three pillars of our foreign aid and why we are gender champions at the U.N., and we're so supportive of the new GPEI gender strategy. Implementation is, of course, easier said than done, but the direction of travel is now clearly in the right direction.

In the polio context, much of the work now hinges on gender because mothers are so often the primary caregivers for their children and because access to immunization is often gender-linked.

The best-known instance is in communities where men who are not relatives are not culturally allowed to enter a woman's home. For example, if a male immunization worker shows up, the children in that house may not be vaccinated.

But there are also broader access issues: women who receive less education are less likely to seek immunization for children. Women might also not be allowed to take their children to a clinic, or they might not be able to afford the transportation there. You also see some nonvaccination of girls as well as delays in seeking treatment for girls, sadly, as a global phenomenon. Globally, we have managed to dramatically narrow that gap, but in certain communities girls fare worse. That's just what the data tell us.

What actions can be taken to ensure health interventions, including those for eradicating polio, meet the needs of all?

I think the polio response has been pretty pioneering in its use and recognition of local women as the backbone and front line. It's a model that clearly works by empowering women who have the best access to their communities and who can best support challenges and problems. They know how many children are in a house as well as the cultural and resource requirements to reach them. Employing these women also provides livelihoods that in turn benefit their families and communities. So I think it's a holistic cycle when you approach it that way.

What has the COVID-19 pandemic shown us about global partnership to meet global health challenges?

[Polio] is a compelling example of collective action and I'm really hopeful that we can manage to emulate this model for the remainder of COVID-19. The pandemic has underscored that coordinated international response results in much better health and economic outcomes than going it alone. It's also a more efficient way for the donor community to contribute. It's especially true for such an interconnected country like the UAE.

COVID-19 has also evidenced how attentive we need to be about the gender dimensions of disease. While women are faring slightly better than men in terms of mortality rates, the pandemic has been disastrous for women's livelihoods. Women are almost twice as likely to lose their jobs and it will almost certainly take them longer to recover their pre-pandemic income levels. Sexual and gender-based violence has also dramatically increased, rightly called the silent pandemic … Without corrective policy and investment along these lines, we are on track to losing years of development, progress, and trillions of dollars’ worth in gross domestic product.