Skip Navigation
Johns Hopkins Bloomberg School of Public Health
Bookmark and Share


Keyword: advocacy

Inactivated Polio Vaccine and Its Role in Eradication Plan

By Lois Privor-Dumm

It’s been just under a decade since the focus of my work shifted to resource-constrained countries. At the time, it seemed a far-off dream that so much progress could be made in protecting children from vaccine-preventable diseases. Eradication efforts had only ever succeeded against one disease – smallpox – and there were still many cases of polio in endemic countries (which at the time were Afghanistan, India, Nigeria, and Pakistan). Immunization was discussed, but never received the focus it does today. Now, on this World Polio Day, I reflect on where the world was and where it is today - closer than ever to reaching a goal of ending polio for good – AND doing it while strengthening immunization programs that have been all too weak in the past.


The rollout of IPV in the Philippines was marked by a ceremony attended by several health dignitaries including the Secretary of Health, Enrique Ona, the Undersecretary of Health, Jeanette Garin and the Assistant Secretary of Health Enrique Tayag among other high-ranking officials.


In 1988, when the Global Polio Eradication Initiative (GPEI) began, polio paralyzed more than 1,000 children worldwide every day. Today thanks to millions of volunteers more than 2.5 billion children have been immunized against polio. Global immunization campaigns have reduced polio by 99% worldwide. Eradication is within reach.

This year kicked off with a huge milestone, with India being declared polio-free in January, leaving just three countries with ongoing transmission. While Pakistan faces many challenges and has seen an increase in polio cases this year, Nigeria has had the fewest cases of wild poliovirus ever, with just six cases so far this year, and Afghanistan’s burden also remains low with just 12 cases this year.

Another important step forward was taken this year as countries began introducing inactivated poliovirus vaccine (IPV), an important milestone in the Polio Eradication and Endgame Strategic Plan, an ambitious but achievable plan endorsed by the World Health Assembly in 2013. The plan calls on countries to introduce at least one dose of IPV into routine immunization schedules and gradually withdraw all oral polio vaccines (OPV). Until now, OPV has been the primary tool in the global polio eradication effort, and has been instrumental to achieving the reach necessary to eliminate polio from all but three countries, and to reduce cases to a mere fraction of historic trends in Nigeria, Pakistan, and Afghanistan. However, new evidence now clearly demonstrates that adding one dose of IPV to multiple doses of OPV is the most effective method available to stop the virus and protect children.

The amazing part is that countries are introducing IPV along with other important new vaccines. In September, Nepal became the first country to introduce IPV with Gavi support. Gavi-supported rollouts will continue, as more than 90% of Gavi-eligible countries have applied for support. Next month, Nepal is also expected to introduce pneumococcal conjugate vaccine. Gone are the days when countries have to wait years between vaccine introductions. In fact, in 2014, five countries have introduced more than one vaccine already, and nearly 15 more multiple introductions are planned for next year, accelerating the path to reducing both child death and severe illness.

But it’s not only Gavi supported countries that are making strides. Middle-income countries, where most of the world’s poor reside, are also recognizing the importance of IPV and making the investment to introduce this and other new vaccines. Earlier this month, the Philippines became one of the first non-GAVI countries to start the transition from an all-OPV schedule to add one dose of IPV. The global rollout of IPV will continue across 126 countries through the end of 2015.

IVAC is proud to be part of the global efforts to help eradicate polio and support the introduction of new vaccines through targeted advocacy efforts in middle-income countries, helping to engage and sensitize civil society, and supporting communications activities of partners. It is a big job ahead, but with committed governments, partners and advocates, we now know it is possible. The hard part of our job as advocates is just beginning, but we look forward to more milestones in the fight against polio in the coming year, as the finish line gets closer.


Lois Privor-Dumm, MIBS, is Director of Policy, Advocacy & Communications

This is the second in a series of profiles to help IVAC partners and friends get to know our team. This one features Chizoba Wonodi, an epidemiologist who leads IVAC’s Nigeria work. We caught up with Chizoba just before she made a big move back to Nigeria with her family. After living in Baltimore for 10 years, Chizoba will now represent IVAC in country, and she will dig deeper into efforts to work with the Nigerian government and other stakeholders to improve routine immunization and increase accountability.

Tell me a bit about your background and when you joined IVAC.

Before coming to Baltimore, I worked as a physician in Nigeria, concentrating mostly on adolescent sexual and reproductive health and HIV/AIDs prevention. I came to Johns Hopkins for my masters in public health and, after that, I went on to the DrPH (Doctor of Public Health) program, completing both programs as a Gates Institute Scholar. In 2006, in my third year of the doctorate program, a colleague introduced me to the PneumoADIP project that would later morph into IVAC. I thought the whole concept of accelerating access to vaccines was novel and cool and I wanted to be part of it. So I sought and got work as student research assistant with PneumoADIP.

When I graduated from my doctoral program in 2009, I joined the Hopkins faculty knowing I wanted to focus my work on Nigeria. My desire has always been to take what I learned at Hopkins and apply it to my home country. At IVAC, I have been able to do just that. My work is to support the Nigerian government in developing effective policies and programs to deliver life-saving vaccines to children. We work alongside many organizations, including the WHO and UNICEF, in helping the government build stronger immunization systems. We do this through policy and operations research, translating evidence to policy, and brokering or advocating for relevant interventions. Instituting accountability within the health system is also a big part of my work in Nigeria.


Chizoba Wonodi with her niece. (Photo credit: Tyrone Shoots)

What inspires you to work in global health? 

I think the potential to make a difference on a large scale drew me to global health.  I came to this realization after medical school, when it was time to choose a clinical specialty. I considered pediatrics because I love children, but I didn’t have the affinity for one-on-one interventions when thousands were dying of preventable causes. I wanted to change things at a broader level. With public health, you can see how the policies and programs you implement affect large populations. 

What does it mean for you to be doing work to help Nigeria?

It is a privilege because not everybody has the opportunity to come to Johns Hopkins, a world-class institution, and receive training from the best in the field and work beside them.  It is wonderful to be able to take what I learned here back to Nigeria and try to make a difference there. However, it isn’t just about taking knowledge back, but also learning from the dynamic changes that have occurred in Nigeria.

Can you explain the kind of dynamic changes Nigeria has gone through?

There is more human capacity than before. In the last decade, a crop of globally educated public health revolutionaries – if I may call them that – have returned home with cutting-edge knowledge, skills, and attitudes. They’ve melded the global perspective with their local knowledge and sensibilities and have become a force for change. They resist doing business as usual and push for decisions to be evidence-based. They are forging partnerships in unusual places, demanding accountability, and focusing on results not just inputs.


Chizoba Wonodi at the National Vaccine Summit in Abuja, Nigeria, April 2012. (Photo courtesy of Tyrone Gibson)

In the vaccine world to be exact, there has been a growing awareness of and greater access to new vaccines. For instance, Haemophilus influenzae type B (Hib) vaccine was introduced last year, hopefully next year, pneumococcal conjugate vaccine (PCV) will follow. Although it took more than 15 years for these new vaccines to become available in the country, the momentum is shifting rapidly as more stakeholders acknowledge the importance of immunization. In April 2012, we saw a massive outpouring of support and promises at the National Vaccine Summit. Many hands are now on deck to help prop up the routine immunization system, and we are seeing positive results. Top among the donors is GAVI, who provides the single largest investment in routine immunization in Nigeria. As more partners come on board, the program space gets crowded and the pace quickens. It is all very exciting. However, one has to be nimble and responsive, to be relevant.

What has been your most rewarding or memorable experience at IVAC?

Seeing the impact of the policies we’ve helped influence result in access to new vaccines for children has been most rewarding. I remember when I came to the PneumoADIP and we were working on the introduction of PCV into developing countries. At that time PCV was considered too expensive for poor countries, but by getting countries to recognize the burden of pneumococcal disease, by convincing vaccine manufactures that there was a market beyond Europe and America, and by mobilizing the right financing, we (and others) helped accelerate PCV introduction into Africa and Asia.

Six years later, it is gratifying to see PCV introduction has outpaced earlier projections. This means many more children (in the millions) are being vaccinated and protected than we ever thought possible. There aren’t many opportunities where you get to contribute to change as big as that.  


At the National Vaccine Summit in Nigeria (left to right): Dr. Ado Mohammad, Executive Director of the National Primary Health Care Development Agency; Dr. David Okello, former WHO Representative for Nigeria; and Dr. Chizoba Wonodi, Epidemiologist and Nigeria Projects Lead at IVAC. (Photo courtesy of Tyrone Gibson)

Wow, that sounds wonderful but also very demanding. What do you do in your free time to relax?

I like to cook. I watch the Food Network to learn new recipes. I love Asian food so I started learning to cook Chinese and now Korean food.

Speaking of cooking and eating, if you could have dinner with anyone – alive or dead – who would you pick and why?

I would choose Nelson Mandela. I don’t think there is anyone in the world as loved and as esteemed. I would like to feel the essence of the man and understand what makes him stand out so much. It would be a wonderful opportunity to learn from someone who has so much compassion, knowledge, and wisdom.

So through our conversation so far, it is obvious you are very proud to be Nigerian. What about Nigeria do you like best?

I love the people. We are proud and very happy people. In fact, there was a study that found Nigerians are the happiest people on earth. You wouldn’t think that given all our challenges and issues; but that is just who we are. We are very welcoming and very hospitable. And I love that when you meet a Nigerian, they proudly proclaim they are Nigerian.

What is your wish for Nigeria?

My immediate wish is that the 2015 elections will come and go flawlessly without any major upheavals. I also hope that the bloodshed in the north will stop so people can get back to living their lives. And I wish that Nigerian leaders would recognize and build our biggest resource – our human resources. Part of that includes making sure girls are educated. Once girls are educated, half the job is done in terms of alleviating poverty, adopting healthy behaviors, and nurturing the next generation.

Lastly, if you could visit anywhere in the world, where would that be and why?

Bhutan. I had a colleague that worked at the Hib Initiative who visited Bhutan. It is very difficult to go there, and you need to have a special reason to visit. My colleague went as a part of a vaccine delegation and she said the country is just pristine, the air is clean and clear, and you can hear birds chirping everywhere. I would love to see that country which has been unspoiled by modern life. 

Oct 2014