WHO’s new director of
polio eradication: the
end is in sight

In February, Michel
Zaffran will take over as director of polio eradication for the
World Health Organization (WHO). Most recently, Zaffran
has served as coordinator of WHO’s Expanded Programme
on Immunization. He has also served as Deputy Executive
Secretary of the Global Alliance for Vaccines and Immuniza-
tions (GAVI), and  represented WHO on the working group
that designed and launched GAVI. We caught up with him
recently to ask his thoughts about this new challenge:

I am extremely excited, but also emotionally very moved,
to have been selected for this position. I started working
for the World Health Organization in September of 1987
in the immunization program. A few months later in May
the World Health Assembly endorsed the resolution to
actually eradicate polio. I was just at a very junior level
but remember seeing my bosses work on the resolution,
and so I was there from the very beginning. So to actually
toward the end of my career be coming back and head-
ing the program for its last miles basically is very exciting
and very moving.

My past experience has prepared me very well for this
role. I have been working with all of the key partners for
many years. And as the WHO’s director of polio eradica-
tion, I will need to interact closely with the various stake-
holders and ensure their contributions remain well coord-
inated.

Over the past three years, specifically as part of the Polio
Eradication End Game Strategic Plan, I was the chair of
the Immunization systems Management Group respons-
ible for coordinating the efforts of partners to prepare for
the withdrawal of  type 2 oral polio vaccine (OPV) from
155 countries and for the introduction of the inactivated
polio vaccine (IPV) into 126 countries. All of this work
has been done very closely with Rotary, with the
Center for Disease Control and Prevention (CDC), the
Gates Foundation, and UNICEF.

We have celebrated some very good milestones
recently, but now is not the time to give up.

So let me talk a little about this important step. As you
know, the OPV is a very efficient and very effective vac-
cine. But in some rare cases, it can actually cause the
disease from the attenuated (weakened) live virus it con-
tains. It can even return to being virulent, circulate, and
cause outbreaks.

There are three strains of the polio virus. Last year,
the Polio Eradication Global Certification Committee
certified that no natural cases of type 2 have occurred
since 1999 and that the virus had been eradicated.
From a public health perspective, it is no longer ac-
ceptable to be causing the disease with the weaken-
ed form of type 2 when it no longer exists in nature.
So during a two week period at the end of April , all
countries that are currently using OPV either in routine
programs or in campaigns — there are 155 such places
— will switch from the trivalent OPV (which contains weak-
ened forms of all three types) to a bivalent OPV (which
only contains types 1 and 3).

At the same time, we are introducing the injectable in-
activated polio virus vaccine (IPV), which contains all
three types of the virus in a killed form, into routine im-
munization systems. This will ensure that people continue
to have protection and immunity against type 2 in case an
outbreak were to occur, either from vaccine not entirely re-
moved or because of an accident at a laboratory or manu-
facturer.

What remains to be done

A child is immunized against polio in Nigeria.

We have celebrated some very good milestones recently,
but now is not the time to give up. The fact that we de-
clared Nigeria no longer endemic, that cases are just
restricted to Pakistan and Afghanistan, sends a signal
— which of course is a very good signal — of positive
results. But at the same time there is a danger it can
obscure the fact that we need to continue for a period
of time to have very good surveillance in Africa and
continue immunizing children. There are countries in
Africa that are at risk, should anything happen, like we
have seen in the past where the virus is imported from
endemic countries.

Rotarians who have been so engaged and active in
helping the program so far cannot let go. They need
to continue to support the program and not only in Paki-
stan and Afghanistan, but in Africa where we need to en-
sure that there are the right campaigns conducted with
high quality. What Rotarians should do is to continue to
advocate that the job is not done yet.

(Rotary) had the vision as early as 1979 that this
should be done and you convinced the rest of t
he world to move ahead and do it.

When we stop transmission in Pakistan and Afghanistan,
and even after we have certification of global eradication,
we will need to maintain high quality surveillance to ensure
the virus is contained and not released into the environment.

And we need to make an effort — and Rotarians can con-
tribute to this substantially — that the lessons learned through
the polio eradication initiative, that the laboratories that we
have established, that the skills that we have developed, that
the staff we have trained, are not lost to public health. But that
they are transitioned to new public health challenges. This is
the fantastic broader legacy of the program.

I would like to recognize the unique role that Rotary and
Rotarians have played in this fantastic adventure. You had
he vision as early as 1979 that this should be done and you
convinced the rest of the world to move ahead and do it. You
have been there at the very beginning; you have been there
all along. Don’t give up now, we are so close, we’ve got the
end in sight.

Learn how you can help us end polio