Polio Eradication With Michel Zaffran

Michel Zaffran is the former Director of Polio Eradication at the World Health Organization. 
In our conversation we talk about polio eradication, vaccines, public health and the role Rotary has to play.

TRANSCRIPT

Peter Tonge 0:20
Welcome to this episode of Talking Rotary. I’m Peter Tonge, and I’m a member of the Rotary Club of Winnipeg Charleswood.

Mandy Kwasnica 0:26
And I’m Mandy Kwasniica Past President and also a member of the Rotary Club of Winnipeg Charlewood. We are so happy you have joined us here and I are so excited for the new podcast and thankful to our many listeners. Let’s start Talking Rotary.

Peter Tonge 1:06
Everyone, welcome to another episode of talking Rotary. I’m Peter Tonge a nd I’m here with Michel Zaffran, Michel, how are you?

Michel Zaffran 1:16
I’m very well. Thank you very much. Good morning, Peter.

Peter Tonge 1:20
Good morning. Good afternoon for you. Because you’re in France right now. Right?

Michel Zaffran 1:24
That’s right. I’m, I’m living in France, just across the border from Switzerland from Geneva where I used to work at the World Health Organization.

Peter Tonge 1:33
Absolutely. We’re gonna get into that. Right away. What’s the name of your Rotary club?

Michel Zaffran 1:39
My Rotary Club is Gex-Divonne. It’s a small Rotary Club, 27 members in the area of France called Pays de Gex.

Peter Tonge 1:49
Okay. I know right, where you are. Right around Lake Geneva. Right?

Michel Zaffran 1:53
That’s right. Yes.

Peter Tonge 1:54
Nice. Okay. Now, Michel, as you mentioned quickly, you spent three years at the World Health Organization as the Director of Polio Eradication. Can you tell me about that? That’s quite the challenge.

Michel Zaffran 2:07
Yes, indeed. Well, I spent 33 years of my career at who in different positions. In the last five years, I was the director of the polio eradication program, and the director of the Global Polio Eradication Initiative. But that was only the five, the five last years that was involved in immunization all these years, but not only specifically on polio, and all childhood immunizations.

Peter Tonge 2:35
Man, so you understand all these things that are going on in the world right now with vaccines and, and pandemics and all that

Michel Zaffran 2:45
In the DSM, because of the department where I used to work, I covered different positions. And I also was involved in some, in some capacity on what we call the pre qualification of vaccine. So you know, the whole discussions on the COVID vaccines, how they were approved by the World Health Organization, all these procedures, these procedures are quite familiar to me. Yes.

Peter Tonge 3:09
Okay. And is that because your background is a medical one?

Michel Zaffran 3:13
Not at all, I actually come from a family of medical doctors and you know, people involved in, in health care with medical degrees. But because everybody was a medical doctor in my family, I decided to be the, the bad boy and go into engineering. And it’s I ended up by who really by accident or by chance, certainly, because public health was in my blog, one way or the other. So I, I was interested in sort of the use of renewable energies in public health in developing countries. And that’s how I started trying to promote the use of solar energy to equip and to provide energy to rural dispensaries in in Africa, mostly, and definitely choke UPS got sort of interested in the work that we were doing, at some point, invited me to come for shorts, sort of contract. And I came to who for six months, and I stayed 33 years.

Peter Tonge 4:23
Some times it end up that way. It ends up being a fit. So let’s talk a little bit about your your your time in polio eradication at the World Health Organization, some of the challenges and some of the successes that you had at that period.

Michel Zaffran 4:41
Well, when I was invited to apply for the position of Director of polio eradication, my predecessor Hamid Jafari told me you know, Michelle, the job is done. Africa is has gotten rid of polio, you really have to deal with only Pakistan. and Afghanistan. So pretty much you know, you’re coming for two years and it will be done. So that was in January of 2016. Join the discussion within 2015. I started in January of 2016. Right. And then in August of 2016, poliovirus were detected in Nigeria, after two years without any polio, in Nigeria in Borno in the Borno State under the control of Boko Haram. So that was a bit of a blow. Africa, we thought eradicated, polio had not eradicated polio, after two years, they had, indeed, viruses in some of the most difficult to reach areas. And we had to work very hard. So, you know, that was the first the first blow the second, the second sort of problem I faced was that Afghanistan and Pakistan, were doing pretty well at the time that I arrived. And then there were elections in Pakistan, which brought in a completely different political party to the party. And that’s this new political party decided to totally change the way that the country was organized. And the Ministry of Health, of course, as one of the, of the Ministries of importance, and that’s disrupted totally the polio eradication program. And when I came 2016 2017, we had very few cases of polio. You know, we had for in Africa, unfortunately, in, in, in Nigeria, but we had very few, maybe 10 or 15, in Pakistan, Afghanistan, so we were really reaching the end. And then there was an explosion of cases, initially in Pakistan, and then spread into Afghanistan. So it was it was a it was a tough five years, because, you know, we were fighting, making sure that polio would be eradicated in Africa. And indeed, it was then focusing on Pakistan with the political difficulties. And that was pretty challenging. And then on top of that, we, we had sort of a surge of outbreaks of vaccine derived polioviruses, which is sort of the the type of, of polio virus which sort of strikes children when, when they they live close to children that are vaccinated, but they themselves are not vaccinated, and then sort of they can be in contact with a vaccine derived virus that would actually be affecting them. So they were many, many cases. So I came at a low, during my tenure, there was a sort of a increases in different places. And then then my last few months were good,indirectly good because of our work, but mostly improved because of COVID. Because the COVID pandemic, in Pakistan actually forced people to stay put. And we’re able to vaccinate them, and not run after the kids that were crossing the borders between Afghanistan and Pakistan. So in fact, the situation today, a year after left is actually pretty good. And you know, the last case in Pakistan that we’ve detected, was in January of 2021. We haven’t had a case of polio since January of 2021. That was my last month or my penultimate month as a director of eradication. We did achieve, you know, a few things while I was a director in spite of these difficulties, and some of them are mentioned in the in the Rotarian article, one thing I’m pretty proud of, because I was coming from broad immunization of children from that sector, before I joined the polio eradication, which is very focused. One thing I’m proud of is that we’ve we’ve agreed with Gavi, the vaccine Alliance, that they would join the Global Polio Eradication Initiative as a full partner and the GAVI Alliance, is a partner that has quite a lot of money raises money for worldwide childhood immunization, introduced all new vaccines in the developing world, and they agreed to finance the inactivated polio virus vaccine, which we all know using all over the world. And this is a more expensive vaccine than the oral vaccines and drugs that we’ve been using for eradication. So having them on board, having them as a funder is been quite a nice success. The other nice thing I was I was pretty proud of is that as you know, there are three types of polio viruses type one, type two, type three.

Peter Tonge 9:45
I didn’t know. Please explain, that was going to be one of my questions. So that’s great.

Michel Zaffran 9:50
Yeah, so there are three types three types of the polio virus. You know, the virologist haven’t been that sort of a call complicated, they’ve just call them type one, type two, type three, the type two, virus hasn’t been seen anywhere in the world since 1999. And it was officially declared eradicated by the World Health Organization in 1920, in 2015, so just one year before I became the director, my predecessor was in charge of that. And that meant that you know, one of the three viruses have disappeared. During my tenure, type three, was officially declared eradicated. So that was in 2019. So we were left fighting, oh, you’re one of the three types of device, meaning the virus has lost two or three wetlands, basically. And this type one, since the last case is in Nigeria, in Africa, in 2016, has only been detected in Pakistan and Afghanistan. So you know, it’s really restricted to two countries. And we’re making progress also with that. And the third sort of achievements during my tenure, and I’ll then hand over the floor back to you to ask questions, was the fact that we’re in spite of the difficulties in Africa, we were able to eradicate the wild poliovirus in Africa. So the last cases were detected. You know, when I arrived in my job in Nigeria, massive amount of work went into avoiding that this virus that was still circulating, without being detected in this sort of small corner of Nigeria, the northeast part of Nigeria, that it would not go and spreads to other neighboring countries, Chad, and Niger, and Cameroon, and, you know, the, the Central African Republic, all of these countries around the Lake Chad, which are pretty complex, also politically, and you know, lots of lots of campaigns, lots of surveillance, and we basically after 27, September of, of 2016, we did not detect the well virus. And in 2020, during my tenure, we were able to get who to certify the eradication of the wild polio virus in Africa. So we now have only one region where we need to eradicate the polio virus. This is the eastern Mediterranean region, with two countries, Pakistan, Afghanistan, and we need to detect the virus as precisely as possible and have good surveillance to make sure that it really disappears. As I said, the last case in Pakistan was on 40, or on in January of 2021. January of, of 2021. So that’s, that’s, that’s 14 months ago, the last case detected in Afghanistan was in January of this year, and the last virus detected in the sewage was in in December in Pakistan. So we are making lots of progress, we have very few cases, very few detection of the virus in the search. And on top of that, I told you about only one type of device type one. But what we are seeing also by sequencing device, because AI labs have become extremely sophisticated. So they do sequencing, genetic sequencing of the virus, we see also that the variety of sequences has shrunk a lot. So we actually are seeing very, very few lineages of device. So it means the virus is has lost two of its three types. And it’s also losing its diversity. It’s becoming very, very, sort of poor in terms of its diversity ability to, to, to paralyze and admits it’s it’s, it’s losing the battle, it’s losing the war, and it’s going to disappear.

Peter Tonge 14:10
Sort of sort of the exact opposite of what’s going on with the COVID virus at the moment we’ve received all these variations that are changing and migrating and performing.

Michel Zaffran 14:21
Unfortunately, the COVID vaccines that we are have available, which are great vaccines, which protect against severe disease, are not vaccines that stop transmission from person to person with our polio virus protects the individual, but it stops the transmission from person to person, which means that eventually if the device doesn’t find people that are not vaccinated, since it cannot replicate outside of the human body, it will disappear, it will die. The COVID The COVID virus unfortunately survives also outside of the human body, so you know, it’s going to be It’s not going to be possible to eradicate but we can do is protect ourselves as well.

Peter Tonge 15:05
Right. It’s interesting for for sort of a lay person, like myself to compare one is shrinking and the other one is, seems to be expanding at the moment.

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Peter Tonge 15:47
So one of the things that I’m wondering about as work being done in Pakistan, in Afghanistan is the political situation in Afghanistan is really complicated yet again, how is that going to impact those efforts?

Michel Zaffran 16:02
Well, contrary to what one one could think the situation was much more difficult. Before the Taliban took over the whole country. When there was a war between the Taliban and the established government, it was extremely difficult to run vaccination campaigns in the areas that were under the control of the Taliban, not because they were against the vaccination, but because they did not want that people from outside of their area, calm, and that they could collect information that will be used by the alliance against them. So they, they basically banned all types of campaigns and so on, forced for two years, a year and a half, almost two years in most of the areas which were under the control, when they took over the country, they actually made it possible and allowed for vaccination to be done everywhere in the country. So since the the takeover in August of last year, the program, you know, after a few weeks of sort of settling down, and so I was able to vaccinate through several National Immunization days, all children in all provinces and all districts of the country. And that explains also that the situation is is also extremely good. I mean, the the situation for polio, of course, there are many other complicated complications and difficulties and terrible things that are happening in this country, especially for for the place of women. And that’s, that’s, that’s sort of a disaster. But from the polio eradication perspective, we are able to access all children and some women are actually also involved in the vaccination campaigns, because they are those who can actually go house to house and go into a compound and knock at the door going to compound and vaccinate. A man would not be allowed to enter a compound which is not of his or family. So there are involved but of course, their their situation is is not good.

Peter Tonge 18:16
Right? No. good, I’m glad you shared that, because I didn’t understand sort of the the impact on the polio program. So that’s, that’s a little piece of good news that you’re now able to get into.

Michel Zaffran 18:28
So one caveat, of course, is that recently, I think, six weeks or two months ago, several vaccinators were killed while doing vaccination campaigns in Afghanistan. They were killed. Because while the Taliban control the whole country, there is still sort of ISIS, which is trying to sort of fight the Taliban. And ISIS is the one that was attempting against the life of the vaccination. So there’s still a war in that country, you know, in some areas, and it can still be very dangerous for the vaccinators to do their job. It was dangerous when there was war between the Taliban and the government, the government, but it’s unfortunately several vaccinators and health workers got killed, it is still dangerous and for them to do the work.

Peter Tonge 19:23
Of course. Now, I’m glad you mentioned the article in the Rotary magazine because that’s how you and I connected so listeners will find that article, the teachers union, the April edition of Rotary magazine. So if they want to learn learn more from what we’re talking about today, that’s there. So we should give a shout out to Rotary Magazine, which is a great resource for me as a podcaster. Now, so I’m wondering, Michelle, where do we go next as far as polio eradication goes?

Michel Zaffran 19:59
Yeah. The the situation is extremely encouraging. But we should, we should understand that the job is not finished. Even though we have very few cases, only one this year, very little virus detection, there’s a need to make sure that the virus does not really establish itself anywhere in the world. Because if we stopped vaccinating, thinking, the job is done. You know, we’ve eradicated the virus. And you know, we’ll have only one case every now and then. We know we know very well know with COVID, that if we let the virus escape, it can reestablish itself in other parts of the world. And in fact, in February, we had the report that the little girl had been paralyzed by the wild poliovirus imported from Pakistan, in Malawi, which is a country in southern Africa, and Eastern southern Southern Africa. So we know that the virus travels. In Malawi, they’re doing campaigns, they’re doing campaigns also in all the countries around Malawi, in Zimbabwe, Tanzania, and so on, to make sure that the virus does not circulate in, go to other countries, but extremely important, because we know that the virus is silent, I mean, it will circulate without being detected for quite a bit of time, in Nigeria, between 2014 and 2016, it was absent, we thought it had disappeared, it had not disappeared. So we really need three years of very good surveillance, both of cases of powerlessness, as well as surveillance of the sewage, to make sure that device has completely disappeared. And during that period of time, we need to vaccinate not only in Pakistan and Afghanistan, but we need to vaccinate in approximately 60 or 65 countries in the world, which are countries where the health system is weak. And if the virus was to come back, it could settle, establish itself and become endemic. Again, if we stop now, within 10 years, and the virus is not eradicated within 10 years, we could actually have 100,000 cases every year all over the world again. So it’s very important that we’ve we push and we continue to support this effort until the very end. So three years, at least a vaccination and surveillance after the last viruses detected by the last kid paralyzed or the last detection in the sewage. And after that, we’ll be able to certify the eradication of the wild boars, that will only be the first part of that story, because we will then also need to stop any possible outbreak caused by the vaccine derived of us. And that will only be possible by stopping altogether the use of the oral vaccine, which contains this live attenuated virus. And that can only be done when we’ve eradicated the wild virus, we withdraw completely the oral vaccine, and we only use the injectable inactivated vaccine, which, which is now being financed by GAVI. And that’s the one that that we use in the US in France and so on, which is a vaccine, which doesn’t have that risk of vaccine derived outbreak. But the disadvantage, the several disadvantages of this vaccine is that it is more expensive. It needs sort of well trained physicians because it’s an injection. And it’s protects you like the COVID vaccine, but it does not prevent you from spreading the virus should you get infected. So that’s why we using the oral vaccine to eradicate when eradication is certified, we can stop the use of the oral vaccine and only use the killed vaccines to kill the virus vaccine, the injectable vaccine, and then, you know, eradication will be completed no more outbreaks of any type.

Peter Tonge 24:20
Thank you. I think that’s a very important message because because I think sort of globally in the public and maybe even within Rotary International, there’s the kind of the perception that we’re you know, we’re we’re very, very close to the end. And in some senses we are. With your messages, there’s still a lot of work to do ahead on the polio eradication side.

Michel Zaffran 24:42
Indeed, we are indeed very, very close to the end. And we as Rotarians can be extremely proud of what has been achieved because it’s it is Rotary International, that decided in 1985 to launch the polio eradication efforts. It was there and followed by the World Health Organization and UNICEF and, you know, the Gates Foundation and so on. But it really watery head first the vision of a world free of polio. So we should be proud of having launched that we should be proud of having mobilized millions of dollars, millions of volunteers, having advocated with governments to for them to finance these these efforts. And the results today, having gone from having 25 countries where the virus was endemic to only two countries today is extraordinary in you know, in good part because of our persistence in supporting these efforts. And that’s why we cannot give up now, we so close, even if it’s going to take three, four more years, we need to continue until the very end, because of all we’ve invested because of the people who have given their their professional career to do that. And some people that have lost their lives, sort of vaccinating the children, we owe it to them. And we of course owe it to children, to whom we’ve promised that we would give them a world without polio.

Peter Tonge 26:08
Exactly. That’s an important message.

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Peter Tonge 27:11
Now , this might be an unfair question, but I’m really gonna try it and we’ll see. So let’s let’s look say five years down the road when polio eradication really has been certified. What what’s what’s then what’s the next role for organizations like rotary to play here? Like, I get the feeling that I Well, I’m concerned that rotary is gonna say job done, and we, you know, we don’t have to work of air anymore. And I don’t feel that way. I just wonder what do you think about that?

Michel Zaffran 27:47
Well, first, we should realize that everything that has been invested in polio eradication has not been invested only for polio. You know, that’s why we call it Paul, your plus. And the plus of polio has contributed to strengthening health systems, immunization programs in many countries in the world. You know, when the COVID pandemic started, our staffing, Pakistan and Afghanistan, in many African countries immediately put itself at the service of the ministers of health to actually help them fight the pandemic. So, so, you know, we put our personnel or logistics, our experience to do all of this. So but in five years, when players eradicated will not be the end of, in my view of, of rotary being involved in public health, we already have many programs all over the world, on malaria fighting malaria on Mother and Child Health for immunization. So you know, it may not be as focused and as intense as the sort of very focused on Polio. But, you know, we are engaged in many, many public health activities all over all around the world, including immunization, including immunization for many childhood vaccines. And I’m pretty sure that if another program was to be considered as possible for eradication, it will not come immediately. But let’s say, you know, there was a sort of agreement of general agreement that a major effort should be launched to eradicate measles, or to eradicate malaria, you know, disease that can be eradicated. You know, Mercury would be a sort of natural sort of strong player in an effort at this time.

Peter Tonge 29:37
And I think that’s very good. So I’m wondering for you, personally, now, now that you’re retired, what’s next for you? Are you really retiring to leisure or do you have other pursuits that you’re taking?

Michel Zaffran 29:50
Well, I’m doing a lot of volunteering, work for rotary. I mean, I’ve been appointed and polio. Now coordinator for zone 13. which is France in part of Belgium. So I’m engaged at the regional level. As a first of July, I’ll be the president of my rotary club. So you know, I will also sort of be engaged at that level. I’m doing volunteer work also for UNICEF and for Gavi, on on vaccine, different types of vaccines, polio vaccines, but also COVID, vaccines, advising procurement groups, on, you know, strategies to that. So I’m still involved, you know, not as intensely in immunization still in pull you through Rotary, still immunization in an advisory capacity. And I’m sort of having a bit more time also to do other things. Like, I like to walk a lot, so I have no time to take long walks in the Israel mountains around you.

Peter Tonge 30:56
You’re in a beautiful area of the world to be someone who loves walking.

I’m gonna ask you my my last question. And that is, there are many organizations in the world that you could be giving your time and your effort to why Rotary International?

Michel Zaffran 31:12
Well, you know, when I was appointed director of polio eradication, quite rapidly. After that, the governor of the district where my club is located, came to visit me, I was little Rotarian them came to visit me who said, Michele, we’re organizing this conference, you know, in your area, would you like to come in and, and present on polio eradication? So yes, sure. I’ll do that. So, you know, that was in June, I went to June 2016, I went to sort of make a speech on the status of the polio eradication program was so good, because I still thought at that time that Africa was clean. And so you know, I had a lot of success, because I was telling people, you know, we, the job is almost done. And two, there were two clubs in my area that that were represented in this district conference. And the Duke, two presidents, two women came to me and said, Michelle, why don’t you become a retain? And I said, Well, you know, I’ve always thought of becoming a Rotarian. But, but I’ve also had the knowledge that, you know, you had to be present at each one of the meetings, have the weekly meetings of the clubs, and you know, I traveled too much. I’m always on the road. So I cannot really, regularly attend the meetings, and it totally Oh, don’t worry, though, Rotary has become much more flexible with that, we’d love to have you as a as a member. So I picked, you know, one of the two clubs and became a routine. And since then, you know, I haven’t been able to leave, it’s just so exciting to I was aware of what reads work at the international level, through the foundation, and through polio eradication. But you know, through my club and the work at the district level, I’ve been involved in local actions, and local sort of support action. So having an organization which has first, this capacity to work at the global level, with a very strong foundation, which is pretty unique in terms of the organizations and be able to have an impact also at the local level, is just extremely exciting and rewarding. And you know, what my club was able to do, and I’m sure what many clubs most of the clubs in the world have done during the pandemic during the lockdowns and so on to actually provide support to those that were most need is, you know, is is nice is really the sort of thing that I want to get engaged in. And, and very rewarding. It’s great. So there are set of people to interact with and very exciting sort of goals. So, to me, it’s almost a no brainer,

Peter Tonge 33:54
Right. Now. I appreciate you sharing that Michelle, thank you very much this this I really appreciate your time and sharing your your noise I certainly learned a lot and I think our listeners will as well.

Mandy Kwasnica 34:33
Thank you so much for joining us on another great episode of talking Rotary. We would love to hear from you. Please send us your comments and story ideas and you can share with us easily by sending us an email at feedback at talking rotary.org Let’s keep talking Rotary.

Transcribed by https://otter.ai

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