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Apr 25, 2024   |   Blog Post

Saving Lives by Saving Time: Improving Polio Lab Sample Transport

polio south sudan
An environmental surveillance team collects samples from the Bugolobi waste water treatment plant in Kampala.

By VillageReach

Originally published in the VillageReach 2023 Annual Impact Report, “Running the Race, Together.” 

In a remote village of Pibor County, South Sudan, fear gripped Nram (1) as he observed his child’s weakening legs. Polio, a disease notorious for crippling limbs, loomed large in his mind. But a ray of hope arrived when health surveillance officers, braving near-impassable roads, reached Nram’s village. They collected a vital sample and commenced the race against time to deliver it to the lab, carefully safeguarding its quality against the scorching heat.

Since the Global Polio Eradication Initiative (GPEI) (2) was founded in 1988, the number of acute flaccid paralysis (AFP) cases due to polio has been reduced by over 99%. However, after COVID-19, we saw a global resurgence of the disease, and it remains the world’s only Public Health Emergency of International Concern (3). The circulating vaccine-derived poliovirus is now being detected in stool samples collected from people in countries as diverse as the Democratic Republic of Congo, Nigeria, Israel, Indonesia and the United States. Wild poliovirus, currently only endemic to Pakistan and Afghanistan, also returned to Malawi and Mozambique. But with great efforts from many partners, those outbreaks were contained within a year. This reemergence generated fresh resolve to operate with an emergency tempo to place the GPEI back on the path to eradication (4).

A key aspect of this resolve is to reduce the time for processing AFP and environmental surveillance (ES) samples from the time of collection, to make results available faster to patients and for rapid planning of the immunization activities necessary to contain outbreaks. Timely delivery of samples from individuals with potential polio symptoms to laboratories remains a significant challenge in many African countries. Samples often take days or weeks to reach their destination, jeopardizing vital testing, delaying management and preventing a timely response to prevent the spread of disease.

The lack of national testing facilities sometimes necessitates international transport, further lengthening the journey. Samples collected in South Sudan, including the one from Nram’s son, are transported to neighboring Uganda for lab testing before the results are returned to communities.

These transport challenges spurred the GPEI to partner with VillageReach to lead a project to significantly enhance the speed and quality of sample delivery from health facilities and communities to national and international labs. Over the past two years, the Polio Lab Sample Transport (5) program has applied our 23 years of work enhancing health supply chains through improved transportation and logistics across Africa to this urgent public health emergency.

Tailored Solutions and Assessments

In 2022, national assessments revealed the extent of the challenges faced in many countries. Those reliant on international shipment struggled to meet the three-day transport timeliness target. Many had significant data issues. In response, VillageReach set about implementing tailored solutions in 15 African countries at risk for polio outbreaks, striving to establish efficient and effective sample transport systems while bolstering sample monitoring, data transparency and quality.

Quality-assured AFP samples are now getting to the lab for analysis more quickly, giving health workers the information they need to control outbreaks. In the eight countries where the three-day transport target wasn’t being met, our tailored interventions helped samples arrive more than eight days faster, a reduction of 38% on average.

The Road Ahead

The global fight against polio continues with fresh urgency. Thirteen of the 15 project countries experienced polio outbreaks in 2022- 2023, demanding creative solutions to speed up sample transportation and maintain sample temperature across vast, hard-to-reach areas. Fortunately, polio is no longer detected in most samples sent to the lab—we are so close to finally eradicating this ancient disease. Together, we will win this fight.

Soon after the surveillance officers had visited Pibor County, South Sudan, exciting news reached Nram: his child did not have polio but a treatable enterovirus. Nram felt a wave of relief for his child and the entire community. This swift diagnosis, brought about by a committed partnership between the government, GPEI and social impact organizations, including Access for Humanity and VillageReach, allowed his child to start the necessary treatment to cure his weakness.

Nram’s story exemplifies the transformative power of collaboration to bring relief to families everywhere. Our job is to take zero chances and ensure that each country’s surveillance system is sensitive enough to detect these sporadic cases and act quickly. By improving laboratory transport systems and investing in sustainable solutions, we can pave the way for a future free from polio, where every child, like Nram’s, has the health care needed to thrive.

(1) Personal information changed to safeguard privacy
(2) Polio Global Eradication Initiative, “Every Last Child”, https://polioeradication.org
(3) World Health Organization, “Polio: As of today, the world’s only Public Health Emergency of International Concern”, https://www.emro.who.int/polio-eradication/news/polio-as-oftoday-
(4) Polio Global Eradication Initiative, “GPEI Strategy 2022-2026”, https://polioeradication.org/gpei-strategy-2022-2026/
(5) VillageReach, “Lab Sample Transport for Polio Eradication”, https://www.villagereach.org/project/polio-laboratory-sample-transport/

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