A Collaborative Initiative to Strengthen Sustainable Public Health Capacity for Polio Eradication and Routine Immunization Activities in the Eastern Mediterranean Region

Abstract

The many challenges in the Eastern Mediterranean region put the involved countries at risk of polio transmission and affect their ability to meet progress targets in eliminating vaccine-preventable diseases. The Global Health Development (GHD) and Eastern Mediterranean Public Health Network (EMPHNET) are working together on the project “Strengthening sustainable public health capacity in the Eastern Mediterranean region for polio eradication and routine immunization activities” with an overall goal of improving routine immunization, eradicating poliovirus, and controlling/eliminating or eradicating other vaccine-preventable diseases in the Eastern Mediterranean region. The aim of this manuscript is to describe the project and the achievements of GHD/EMPHNET over the last 3 years (2016-2018) to build effective surveillance and immunization systems in the Eastern Mediterranean region through the development of a sustainable and competent public health system to eradicate polio and control/eliminate vaccine-preventable diseases. This project assists the targeted Eastern Mediterranean region countries to build effective surveillance and immunization systems in an effort to expand their capacities to eradicate polio and control/eliminate other vaccine-preventable diseases. The project is streamlined with the Global Polio Eradication Initiative, the Centers for Disease Control and Prevention’s Strategic Framework for Global Immunization 2016-2020, and the Polio Eradication and Endgame Strategic Plan 2013-2018. The project also supports the Global Health Security Agenda by focusing on efforts to accelerate progress toward a world safe and secure from infectious disease threats. Project activities were designed to respond to countries’ needs and assist them in building their institutional and workforce capacity to effectively plan, implement, and evaluate activities to eradicate polio and strengthen routine immunization activities. The project activities covered a set of areas including surveillance of acute flaccid paralysis and other vaccine-preventable diseases, family and community engagement, workforce capacity building, improvement of data quality, management and use of information systems, use of polio assets to control/eliminate other vaccine-preventable diseases, support of countries to develop national strategies, piloting of innovative initiatives, program evaluation and accountability, and immunization strengthening. The project adopts the Global Polio Eradication Initiative strategies for assisting countries to strengthen routine immunization services, maintain highly sensitive acute flaccid paralysis surveillance, and sustain polio eradication functions.

Operationalising Regional Cooperation for Infectious Disease Control: A Scoping Review of Regional Disease Control Bodies and Networks

“…Enablers related to organisational factors discussed in the various papers included an understanding of the regional context, 23,24 effective information technology systems, 23 and a functional surveillance system, [25][26][27][28][29][30] although achieving the latter could be perceived as an aim.…”

“…Barriers included lack of understanding of the regional context (eg, presence of refugee and migrant populations), 23,31 unstable political situations, 31,32 a lack of political will, 33 lack of data so a lack of awareness of the existing situation at all levels, 34,35 including policymakers, inter-country differences, including the structure of the surveillance systems, recognition of cultural and political factors (including different languages). 36 Others were a lack of trust and transparency, as some countries may not be inclined to report outbreaks of infectious disease (for example, as these may have potential effects on tourism and trade), 34,37 insufficient capacity to plan, mobilise and implement control strategies, 33,[38][39][40] and the necessity of complying with local regulations in-country.…”

“…26 The Eastern Mediterranean Public Health Network (EMPHNET) was initiated as a result of regional humanitarian crises and increased likelihood of spread of infectious disease, and complex health needs among refugee and migrant populations. 23,31,42 To promote understanding of context, focal people were identified in each country to increase collaboration through conference calls, email, and country visits, to allow the administration of effective immunisation programmes and address the potential spread of vaccinepreventable disease in the region, and to foster accountability.…”

“…Data on existing gaps and requirements from each country were collected and analysed and ministries of health and country experts, with support from WHO and UNICEF, met and designed plans. 23,31 One major issue for the ProVAC network was the lack of national data on disease burden and surveillance systems, making it difficult to plan cost-effective vaccination programmes. 34 Networks Enablers included establishing collaborative platforms, 45 sharing knowledge, 46 and building effective relationships, including public-private partnerships.…”

Field Epidemiology and Public Health Research Priorities in the Eastern Mediterranean Region: Delphi Technique

“…The EMR has seen a great improvement in routine vaccination coverage, but political unrest, complex emergencies, humanitarian crises and socioeconomic hardship affecting the region have caused disruption of immunization systems in several countries. For example, the coverage of the Diphtheria, Tetanus and Pertussis vaccine and third dose of the oral polio vaccine in the region has dropped form 86% in 2010 to 80% in 2015, with wide inter-and intra-country differences ( 25 ).…”