Polio Eradication Cross-border Coordination Plan 2024 - 2025: Lake Chad Basin and Sahel Countries

"...the importance of a formally established and empowered coordination task force that tackles cross-cutting issues facing countries, provides innovative strategies, secures additional resources, implements organizational directives, and enables country ownership in coordinating cross -border activities for polio eradication."

Across Africa, the transnational spread of polioviruses is one of the greatest challenges that countries face in their attempts to stop transmission. The virus spreads easily across borders, which are often highly porous. These areas are often missed in planning unless both sides coordinate effectively to ensure comprehensive coverage. The goal of this plan is to achieve the interruption of poliovirus transmission across the Lake Chad Basin and the Sahel by the end of 2025 and the certification of elimination by the end of 2028 by:

• Fostering government ownership and leadership and enhancing partner support;
• Establishing and strengthening multi-country coordination mechanisms;
• Enhancing cross-border surveillance and mapping high-risk populations;
• Optimising cross-border immunisation strategies and synchronising implementation; and
• Jointly addressing community engagement and advocacy challenges facing populations living along common borders and high-risk mobile populations.

As the report explains, an estimated 7 million people living along the common borders regularly engage in cross-border movements for trade, social activities, and migration. Vaccination efforts are further complicated by limited accessibility and security concerns. Based on the current epidemiology and subregional risk assessments, there are areas within the Lake Chad Basin and Sahel subregion that are regarded as very high risk for transmission of the type 2 variant poliovirus. Between 2022 and 2024, 33 cases and 17 environmental isolates have been traced to other countries (data as of 4 August 2024).

In light of this situation, discussions between seven key countries - Burkina Faso, Cameroon, Central African Republic, Chad, Mali, Niger, and Nigeria - took place in late July and early August 2024 in Brazzaville, Republic of Congo, at Global Polio Eradication Initiative (GPEI) cross-border coordination technical meetings. Participants deliberated on coordination mechanisms and refined the actions laid out in this plan.

In the past, several formal and informal structures have played a role in managing cross-border polio eradication activities in the region. For example, in the Lake Chad Basin, a similar coordination mechanism was established from 2016 to 2018 for Cameroon, Central African Republic, Chad, Niger, and Nigeria. The challenges of high population movement, insecurity, and political fragmentation, which complicated efforts to implement a joint strategy across the subregion, underscored the importance of adaptable strategies that can navigate political complexities and engage multiple stakeholders effectively. In insecure areas, innovative solutions, such as engaging communities and leveraging local actors and partners, were essential to improving vaccine coverage. A significant takeaway is that addressing the cross-border transmission requires more than just vaccination campaigns.

The 2024-2025 plan emphasises an aggressive outbreak response strategy, treating all polio cases, including those linked to circulating variant polioviruses, with the same urgency as wild poliovirus. Central to this strategy is the Lake Chad Basin Task Team, a coordination office based in N'djamena, Chad, to centralise the polio response. This mechanism will help health authorities, technical teams, and countries to better coordinate by sharing information in real time for informed public health decisions. For example, case reporting and coordination is facilitated via text messaging or with internet-based messaging applications, such as WhatsApp.

Examples of actions envisioned by the plan include:

• Community engagement and social mobilisation:
  • Developing social mapping of border districts (such as languages, leaders, non-governmental organisations (NGOs), associations, communities, and communication channels, etc.);
  • Setting up cross-border community engagement units involving authorities, community and religious leaders, nomads, refugees, migrants, and leaders of internally displaced persons, for social mobilisation in relation to polio interventions;
  • Developing a joint, cross-border communication plan, integrating perception, social and behavioural surveys, and lessons learned; and
  • Identifying women champions and influencers in border areas for social mobilisation and immunisation activities.
• Consistent and unified messaging:
  • Developing joint and harmonised message packages for routine immunisation and polio cross-border response; co-creating communication tools and materials adapted to the local context of border communities; and
  • Harmonising message banks and communication and advocacy materials on polio and routine immunisation to be used in cross-border activities.
• High-level advocacy:
  • Developing a joint communication plan that emphasises the need for ministries of health of neighbouring countries to coordinate communication activities (including, if possible, joint press releases, launch of joint campaigns in multiple countries at the same time, etc.);
  • Mobilising heads of government engagement to support cross-border activities and request the collaboration of all relevant ministries;
  • Obtaining the relevant ministers' support to allow health workers to work together at the local level to ensure that no child is missed;
  • Incentivising the launch of synchronised campaigns by the authorities of the border states, regions, and provinces, where feasible;
  • Calling on the ministries responsible for the implementation of the One Health approach to strengthen their support for the cross-border activities;
  • Urging NGOs operating in public health emergencies to integrate relevant messages and routine immunisation interventions in their action; and
  • Developing joint cross-border community engagement activities/messages involving traditional influencers, religious, nomadic, and clan/tribe leaders to gain community trust and support for surveillance and vaccination, before, during, after, and outside of polio campaigns and other routine immunisation activities.

An monitoring and accountability framework will be established, with regular ministerial dialogues to evaluate progress and address challenges, ensuring the sustained momentum needed to achieve the goal of eradicating variant poliovirus in the region.
 

Click here for the 24-page report in French in PDF format.