In 2019, Ghana’s decade-long polio-free status came to a halt. The country awoke to news of an outbreak of circulating vaccine-derived poliovirus type 2 (cVDPV2), and Ghana’s Ministry of Health declared a public health emergency of national concern. WHO immediately swung into action, liaised with the Ghana Health Service (GHS), and initiated investigation as per International Health Regulation (2005). WHO’s Country Office (WCO) oriented the investigation team on various guidelines, prepared risk assessments and presented this assessment to Global Polio Eradication Initiative partners (GEPI) within 72 hours of the confirmation of the outbreak. The assessment covered critical factors that influenced the type and scope of response and allowed GPEI to recommend appropriate response actions.

Between December 2019 to February 2020, WHO—in partnership with UNICEF, GAVI, Ministry of Health (MoH) and the GHS—initiated Polio Supplementary Immunization Activities (SIA) to protect 4.5 million at-risk children, across eight regions in Ghana. However, the onset of COVID-19 interrupted Phase-3 of the planned response. Concerns around infection rates brought basic health service delivery to a halt, including immunization. WCO recognized the immediate need to train frontline workers in infection prevention and control (IPC) protocols—thus building the Government’s confidence and securing buy-in for reinitiating the polio vaccination campaign. Between March and September 2020, the WCO trained vaccinators, volunteers and supervisors on IPC, and provided them with personal protective equipment and alcohol-based hand sanitizers to ensure optimal infection prevention. In September 2020, the MoH approved a re-launch of the vaccination campaign and 95.4% of vulnerable at-risk children, across 130 districts were vaccinated. Since the campaign was rolled-out, Ghana has not reported any case of cVDPV2. Behind the success of this campaign, are three pivotal strategies implemented by WHO and GEPI partners:

1. Harnessing the power of social mobilization. In the initial stages of the re-launch, the campaign hit many roadblocks in delivery and faced daunting challenges in service uptake. Rumours that the government was using polio as a decoy to test COVID-19 vaccines, fueled suspicion and skepticism—increasing vaccination resistance. WCO leveraged ‘social mobilization’ as a strategy to increase uptake, collaborating widely with other GEPI partners and government functionaries to reach specific groups of people—particularly those most vulnerable—for intentional dialogue. To prevent low vaccine compliance, collaborators designed a public health campaign, showcasing data on the reduction of vaccine preventable diseases in the country. Furthermore, frontline workers engaged with community members to understand their concerns and subsequently designed campaign messages to address them. Social mobilization ensured that every eligible child was reached and vaccinated. Door-to-door vaccination drives also became a medium to deliver key health messages related to COVID-19: personal hygiene, good sanitation practices and adherence to COVID-safety protocols by caregivers.
2. Strengthening health surveillance systems. The social mobilization campaign offered an opportunity to further strengthen existing health surveillance systems—ensuring that no eligible child was missed. In partnership with the MoH,  WCO set up a polio emergency operations center (P-EOC) that enabled real-time tracking and monitoring of activities in all response areas. To strengthen existing surveillance systems, WCO provided tools that allowed digitalizing data collection and monitoring—including ultra-modern GIS-based facilities. WCO also established regional-level P-EOCs and recruited surge officers who were deployed to high-risk regions in Ghana, thus enhancing polio surveillance activities. These surveillance officers not only tracked progress, but also built the capacity of lower-level staff to detect and investigate AFP cases. These efforts will serve well in the event of future outbreaks. Should Ghana experience another health emergency in the future, established regional-level P-EOCs, digitalized data collection tools, trained frontline workers and strengthened surveillance mechanisms will ensure last mile reach and coverage.
3.  Enhancing the efficiency of vaccine management and logistics systems. In coordination with other GEPI partners, the WCO streamlined all logistics needed to successfully implement the polio campaign. This included the safe transportation of vaccines, effective vaccine retrieval and destruction of open/partially used vials. The WCO played a lead role in enhancing the efficiency of vaccine management and logistics systems for vaccine delivery. Contributions from the WCO team included providing guidance for implementation (SOPs and guidelines), technical support for operational and data management activities, culturally-relevant SBCC materials, and monitoring support.

Through the CVDPV2 outbreak response, Ghana’s health system was significantly strengthened. By harnessing social mobilization, building the capacity of the health workforce, introducing e-surveillance and geo-coding, establishing regional-level polio-EOCs and streamlining all logistics for vaccine management—WCO has ensured that Ghana’s health system is primed to respond to any future outbreak.

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Photo caption: Trained Community Volunteers supporting to vaccinate children, an example of community participation.

Photo credit: WHO

Disclaimer: This image was taken during a time of no community transmission of COVID-19. Community transmission is defined as the inability to relate confirmed cases through chains of transmission for a large number of cases, or by increasing positive tests through sentinel samples (routine systematic testing of respiratory samples from established laboratories). Preventative measures such as mask wearing and physical distancing should be used to prevent the spread of COVID-19.