Contagious Conversations / Episode 6: Ending Polio for Good
On the final frontlines of a historic effort
Now that Rotary International has helped immunize more than 2.5 billion children in 122 countries, polio remains endemic only in Afghanistan, Nigeria and Pakistan. Carol Pandak discusses her work with the organization to end the disease once and for all...and what challenges still remain.
Below: Carol Pandak (center) travels in 2017 with Nigeria’s National PolioPlus Committee to discuss and address the challenges in ensuring that every child in Nigeria is reached with the polio vaccine.
Transcript
Claire Stinson: Hello and welcome to Contagious Conversations. I'm your host, Claire Stinson. Every episode we'll hear from inspiring leaders and innovators who make the world healthier and safer for us all. Contagious Conversations is brought to you by the CDC Foundation, an independent nonprofit that builds partnerships to help the Centers for Disease Control and Prevention save and improve more lives.
Joining me today is Carol Pandak, the director of PolioPlus, Rotary International's global effort to eradicate polio. Pandak has served in this role since 2000, where she leads day to day operations and oversees the program's administration, advocacy efforts, grants, finances and volunteer engagement. In this role she also works closely with global program partners such as the World Health Organization, UNICEF, the Centers for Disease Control and Prevention and the Bill & Melinda Gates Foundation. In this episode, Carol shares the progress we've made in polio eradication and how health workers are making an impact in their communities. Welcome, Carol.
Carol Pandak: Thank you very much. Pleased to be here.
Claire Stinson: So Carol, let's start today by talking a little bit about your background. Throughout your career, you have worked for national and international nonprofit organizations including Rotary International, The American Academy of Pediatrics and the Society of Actuaries. What would you say lead you to this point in your career?
Carol Pandak: Well I have an interest in working in the nonprofit sector and I have a doctorate in adult education where I looked at the nonprofit sector in Hungary actually, my background is Hungarian. And so, I've always been interested in the nonprofit sector and very interested in what Rotary was doing and became familiar with their work in polio eradication.
Claire Stinson: Interesting. And polio is such a fascinating disease, what would you say drew you to the world of polio eradication?
Carol Pandak: To be able to say that you've worked on something that improves the lives of children I think is really important and to be part of history, the global effort to eradicate polio is historic, only one other human disease has been eradicated and that's smallpox, so being part of history and a global program that protects children, mainly under the age of five, from polio is really, I think important and something I'm very honored to work on.
Claire Stinson: Absolutely. So tell us a little bit about the goal of Rotary International. Why did Rotary get involved in polio eradication and what is Rotary's role in the eradication effort?
Carol Pandak: Well Rotary is recognized as the organization that first had the vision of a polio-free world. In fact, in 1979 we did our first polio immunization activity in the Philippines. We were looking for a project to celebrate the 75th anniversary of our Rotary Foundation and one of our directors from the Philippines suggested working on polio eradication as did Dr. John Sever who was with the National Institutes of Health. So we did our first project in the Philippines, immunized six million children against polio there. It was quite successful. The Philippines at the time had the highest burden of polio disease in the western Pacific area.
So we replicated that project in five other countries and that lead to the launching of our Polio Plus program in 1985, which was a fundraising effort to raise 100 million dollars to immunize the world’s children against polio and our goal was $100 million and we ultimately raised 247 million dollars. And that got the attention of the World Health Organization, UNICEF, we've been talking with them for quite some time, and in 1988 the World Health Assembly adopted the resolution to eradicate polio partly because Rotary had raised this tremendous amount of funds and had a legion of volunteers. We have 1.2 million members globally who were ready to help support the effort.
Claire Stinson: Well that's quite a bit of progress, congratulations on that. So, the eradication effort has been going on since 1988 and there has been this steady progress but things have now slowed. What would you say is behind that?
Carol Pandak: First, I'd like to address the progress. Because in 1988 there were some 350,000 causes of polio every year, last year there were only 33 cases in 2018. In 1988, 125 countries were endemic for the wild poliovirus, in 2018 only Pakistan and Afghanistan were reporting polio cases, so there has been tremendous progress since 1988. We are facing some challenges in Pakistan and Afghanistan reaching every child with the polio vaccine. That's where we are today.
Claire Stinson: So, you're certainly very knowledgeable about polio. In your opinion, how are we going to eradicate polio?
Carol Pandak: Well, we're going to eradicate polio by ensuring that every child under the age of five gets vaccinated against polio, and we also have to be listening to communities about what else they’re interested in. Some of these places where polio still exists are some of the most deprived communities and so, it's not only polio that they're maybe concerned about it, there could be other diseases. And so, trying to figure out a way to work with communities to build trust in communities so that they are welcoming of vaccinators that are bringing polio and then maybe some additional complementary services to address other high priority needs in the community.
Claire Stinson: We'll be right back with Carol.
Since this is a show about Contagious Conversations, we want to hear from you. Each episode we'll ask you a question, and this episode's question is do you know someone who has been impacted by polio? Just email info@cdcfoundation.org to answer. That's info@cdcfoundation.org. And if you share your thoughts with us, you'll have the chance to win some CDC Foundation merchandise. And now, back to our conversation with Carol.
What would you say is the biggest challenge to eradication?
Carol Pandak: I think the biggest challenge to eradication is really building the community trust in all the places where we need to work. Being able to reach all children with the vaccine. It's interesting because in Pakistan, 95 percent of parents are open to immunizing their children against polio. It's really convincing a smaller population who may have some concerns about the vaccine figuring out how to reach their children with the vaccine.
Claire Stinson: So, we know that health workers involved in eradicating polio can sometimes be in dangerous situations working to vaccinate children where the disease is still endemic. Can you tell me more about what it's like for those working in the field?
Carol Pandak: Most of the frontline workers are female, many of them are female. There's a reason, because these women can enter compounds and enter households and talk with mothers about the importance of vaccination and provide other health information while they're doing that. It's a hard job because frontline workers aren't just working during polio vaccination campaigns, there's also a group of frontline workers called community-based mobilizers, and these people are working in between the rounds, talking to parents about the benefits of immunization, other health priorities as I suggested. And so, it is almost a full-time job to be going out in communities, building trust, talking to parents, answering questions. And it can be hard work, it's hot, maybe it's dusty, you're going door-to-door, so it's not like people are coming to you, you're going to them every day talking to people about various health issues including polio.
Claire Stinson: Oh, wow. So that's a really interesting job, tell me more. How do you become a community mobilizer?
Carol Pandak: Well you get selected from your community. I was just in Nigeria actually, I don't know two weeks ago or ten days ago, I can't remember now, and met some of these community mobilizers and they are selected, the community puts them forward and then there is kind of a panel that makes the selection of these community mobilizers. And these tend to be women who are influential in their communities, have the respect of their community members and have dedicated themselves to the health of the children in their communities, and what we call their territories can be quite small, because you want to make sure that the community mobilizer is very well known in the community, so the people are very comfortable with that person going door-to-door and talking to them on their doorstep.
Claire Stinson: Right, that makes sense but sounds like such an important position to hold in the community. That's something to really be proud of that those folks are really helping their communities in such an important way.
Carol Pandak: Yeah, that's absolutely the feeling I got when I was meeting with them. They had the opportunity to present the work that they do, how they do their work and go about their days. And lots of pride in what they're doing and of course there's supervisors also that provide some oversight to help them do their jobs well and so, there is this level of accountability also built into this system so that the activities are of the highest quality.
Claire Stinson: But it sounds like sometimes it can be dangerous. So what would you say is the biggest danger to them?
Carol Pandak: Some people are reluctant to have their children vaccinated and are maybe frustrated that either a community mobilizer or a vaccinator has come to their home so frequently and only bringing the polio vaccine, that's one thing that we've heard. So I think there's just a level of frustration at the lack of other services that perhaps are being provided to them in some of these communities that are very, very deprived. And that's something we're working on in Rotary is working on as well is how do you bring some of these complementary services? For example, we've put in a water filtration plant in one of the large slum areas in Karachi next door to a facility that's providing vaccinations, polio plus other vaccinations, so trying to meet those felt needs of communities so that their level of trust increases and their frustration decreases.
Claire Stinson: Makes sense, and all really important goals. Thank you for sharing that. Carol, I understand you have background in understanding the psychology of vaccine hesitancy, talk to me about that as this is a really important topic in today's world.
Carol Pandak: Right. I think we see in the media and we know that this is an issue that is actually becoming a global issue. There's hesitancy in the United States, we see it in places like Pakistan and other countries, I think part of the issue is that parents don't see these diseases anymore and we have forgotten what these diseases look like, that most young mothers would not be able to tell you what it looks like for a child to have polio, or they don't know anybody who's had polio and how devastating it can be over a lifetime and the same with measles or other diseases that are vaccine preventable. So I think part of it is the progress that we've made against these vaccine-preventable diseases have made them a distant memory for many people.
Claire Stinson: All really important points. So how, in your view, do we overcome this hesitancy?
Carol Pandak: I think it is with dialogues. I think it's dialogue with mothers, dialogues with fathers, with people that they trust, right? And it's what we do in Pakistan, it's what we do in Nigeria is that you get the community influencers―it could be a religious leader that people trust, really understanding who people respond to and filtering information to them through that mechanism, so that they feel like they can trust the information that they're receiving.
Claire Stinson: Have you seen success with that model?
Carol Pandak: I have, to be honest. I have, in all my time going to Pakistan or Nigeria, I've never seen anybody refuse the vaccine and so, I think vaccine refusal is an issue. It can be overcome using these mechanisms that we've used in Pakistan, Nigeria, and India was probably the first example of really engaging the influential women in the community to address the concern to parents.
Claire Stinson: Well that's great to hear. So it sounds like you have a lot of interesting and powerful stories from your travels. Is there one particular story from all of your travel experiences with Rotary International that stands out to you as really powerful?
Carol Pandak: I would say the most powerful experience though is the first time I immunized a child in India. It is really a profound experience and it was in an area where these huts where made of just cloth and sticks and somebody handed me a baby wrapped in pink and she had coal around her eyes, and I immunized her against polio. When I handed her back, and I thought I was handing her back to her mother, but I was actually handing her back to maybe a six-year-old who had brought her sister to be immunized. And for that one moment I thought, "Gosh, I'm not sure I really want to let this baby go.” But it was children raising children because the parents were out working. And just for that moment when you're immunizing that child, you are the only two people on the planet, that child and you, and you think, "Wow, this kid's going to have maybe a tough go of it but it won't be polio that makes her life difficult.” So that happened very, very early in my experience with Rotary and it certainly has I think defined my work since that time.
More recently I was up in Borno, Nigeria, in one of the internally displaced persons camps because of the conflict up there, and we were putting in a borehole there to provide clean water to the community and we immunized children against polio. And the mothers very much wanted their children to be immunized against polio and I thought about the difficult lives that these people were living and yet the health of their children was a priority. And so, just being in that setting with these makeshift homes, providing vaccines to children who again, are going to have a hard go of it perhaps, but it won't be polio. And that there was a program, a global program that was available to them to provide that protection against polio.
Claire Stinson: All really powerful stories, it sounds like you have met a lot of really amazing people in your travels. Is there one person that really stands out to you as the most impactful?
Carol Pandak: The women that are on the frontlines, I think those are the women that I really appreciate. And their dedication to the children in their community and doing the hard work. And it can be very, very hot, and the hours can be very long and just wanting to protect their children and provide for the children in their community just amazes me and makes me respect them just so much.
Claire Stinson: That's amazing. Thanks for sharing that. So Carol, you've had a really interesting background, what career advice do you have for the future public health leaders for America, and maybe even internationally?
Carol Pandak: Well, I think my advice is you don't necessarily have to be an epidemiologist to be in public health. All sorts of expertise are required in public health, there's so much around communication, information, education, advocacy, reaching out to government to get them to prioritize polio eradication, or whatever issue you happen to be working on. There's the financial aspect of it, so I think if people are interested in global health, any skill that you have can be applied to a global health initiative and I would encourage everybody who's interested to think about how they can use their skills, because as I said a whole range of skills are needed to make a successful global health program.
Claire Stinson: Really important advice. Carol, thank you so much for sharing your story with us, we have learned a lot about polio eradication and I enjoyed talking with you today.
Carol Pandak: Thank you very much.
Claire Stinson: Thanks for listening to Contagious Conversations produced by the CDC Foundation and available wherever you get your podcasts. Be sure to visit cdcfoundation.org/conversations for show notes and bonus content and if you like what you just heard, please pass it along to your colleagues and friends, rate the show, leave a review and tell others. It helps us get the word out. Thanks again for tuning in and join us next time for another episode of Contagious Conversations.