In February 2022, a single case of Wild Polio Virus 1 sent shockwaves in Malawi, a case of a 14-year-old child in Ndirande, Blantyre changing the focus from under 5 routine immunization at birth to children aged 0-15 group as a target to combat the outbreak. The virus was genetically linked to a sequence from Pakistan, detected two years’ prior in Sindh province. Swift action was imperative, and within 24 hours, through decisive leadership, Malawi's President declared a National Public Health Emergency and response activities commenced immediately.

The response was led by the Ministry of Health and supported by the Global Polio Eradication Initiative (GPEI) and its partners with the goals of bridging immunity gaps and strengthening surveillance to detect, contain, respond and halt any further spread of the virus.

To bridge community immunity, between March 2022 and September 2023, six rounds of door-to-door Polio vaccination campaigns were implemented country-wide targeting children under 5- 15 with progressive improvement in performance in each round.  This was evidenced by the number of districts passing the Lot Quality Assurance Assessment with each round. The successful implementation of each round was due to the commitment of health of workers to leave no child behind.  Door to Door they trekked across hills, traversed long distances, and reached hard-to-reach communities.

"Our aim is to ensure that all children are vaccinated. Apart from practicing hygiene, it is the only effective way to protect our children. Polio has no cure, once it hits there is no turning back. It is therefore everyone’s duty, whether men or women of every to ensure that our children are protected,” Lusungu Gondwe a Health Surveillance Assistant at Chilobwe Health Centre in Blantyre

According to Minister of Health, Hon Khumbize Kandodo Chiponda their unwavering commitment ensured no child was left unvaccinated. These tireless individuals contributed immensely to the response as confirmed in in her speech at the World Health Assembly, May 2024.

Beyond the campaigns, routine immunization systems were also strengthened to expand reach and access for all. Several outreach sites especially in hard- to- reach and difficult to access terrains were established. Systems were also established to ensure continuity of routine immunization services given the other ongoing emergencies namely Cholera, COVID-19, climate related floods and Cyclones. This included provision of immunization services in internally displaced persons camps, refugee centres and temporary relocation sites.

Strengthening Surveillance

WHO Malawi Country Representative Dr Neema Rusibamayila Kimambo explains that with support from WHO, UNICEF and other GPEI partners, international and local surge staff were deployed at various stages of the response to support gap- filling, knowledge and skill transfer processes in relation to vaccine preventable disease surveillance to bridge human resource gaps at both national and subnational levels.

“To further enhance surveillance, WHO supported the establishment of an environmental surveillance system in Malawi. These sites have been critical in monitoring enterovirus burden within environmental sites using sewage samples. The response involved intensified cross- border collaboration in surveillance given the simultaneous outbreak which was occurring in Mozambique. Through strong inter- governmental collaboration and joint planning key activities such as synchronized campaigns, cross- border surveillance meetings and joint review sessions facilitated enhanced monitoring across borders given that viruses have no geographical barriers” Dr Kimambo explains.

Innovation in Emergency Response

In the fight against polio, innovation played a pivotal role. Increased supervision at the district level improved campaign efficiency was done with the use of real- time and geo mapped electronic monitoring system to ensure accountability, visibility and effective use of data to inform decision making with support from WHO. UNICEF provided support for the use of drones to deliver vaccines to distant areas, bridging geographical gaps and Gavi, the Vaccine People for the provision of the polio vaccine.

The World Health Organisation piloted the use of Mobile money digital payment systems for the reimbursement for activity funds for health workers. The use of this platform of mobile money ensured timely payments to health workers, reducing missed transactions, ensuring health workers motivation and satisfaction.

The Assessment and Triumph

In May 2024, an independent Polio Outbreak Response Assessment Team (OBRA) following two in-country assessments and review of key documents declared Malawi and Mozambique as having no evidence of ongoing Wild Polio Virus (Type 1) transmission. Marking the end of the outbreak in the entire African region. The virus had been interrupted. Following this declaration, the government of Malawi received well-deserved recognition at the World Health Assembly.

This success reaffirms a timeless belief: where there's political will, collaboration, community engagement, multisectoral support, and innovative technology, health outcomes can improve dramatically. Malawi's triumph over polio stands as a testament to dedication—a beacon of hope for global health.