Global polio eradication now hinges on four countries

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The world's success in eradicating polio now depends on four countries -- Afghanistan, India, Nigeria, and Pakistan -- according to the Advisory Committee on Polio Eradication (ACPE), the independent oversight body of the eradication effort.

With a targeted vaccine and faster ways of tracking the virus, most countries that recently suffered outbreaks are again polio-free. In parts of the four endemic countries, however, there is a persistent failure to vaccinate all children, and polio-free countries are considering new measures to help protect themselves from future outbreaks.

"With a more effective monovalent vaccine and accelerated lab processes for identifying poliovirus, these countries have the best tools we've ever had," noted Dr Stephen Cochi, Chair of the ACPE and Senior Adviser to the Director of the Global Immunization Division at the US Centers for Disease Control and Prevention. "Eradicating polio is no longer a technical issue alone. Success is now more a question of the political will to ensure effective administration at all levels so that all children get vaccine."

As an illustration, the office of Afghan President Hamid Karzai has already taken direct oversight of polio vaccinations, following the sharp increase in cases in the Southern Region of Afghanistan.

Given that all children paralysed by polio in the world this year were infected by virus originating in one of the four endemic countries, polio-free countries are now taking new measures to protect themselves. The Ministry of Health of Saudi Arabia, for example, will be enforcing stringent polio immunization requirements for the upcoming pilgrimage to Mecca.

"Polio eradication hinges on vaccine supply, community acceptance, funding and political will. The first three are in place. The last will make the difference," said Dr Robert Scott, Chair of Rotary International's PolioPlus Committee, speaking on behalf of the spearheading partners of the Global Polio Eradication Initiative. Rotary is the top private-sector contributor and volunteer arm of the Initiative, having contributed US$600 million and countless volunteer hours in the field since 1985.

The ACPE advised the four polio-endemic countries to set realistic target dates for stopping transmission, noting that improvements in reaching all children in these areas have been only incremental, and that these countries will take more than 12 months to end polio.

The Global Polio Eradication Initiative is spearheaded by national governments, the World Health Organization (WHO), Rotary International, the US Centers for Disease Control and Prevention (CDC) and UNICEF.

The polio eradication coalition includes governments of countries affected by polio; private sector foundations (including United Nations Foundation, Bill & Melinda Gates Foundation); development banks (including the World Bank, the African Development Bank); donor governments (including Australia, Austria, Belgium, Canada, the Czech Republic, Denmark, Finland, France, Germany, Hungary, Iceland, Ireland, Italy, Japan, Luxembourg, Malaysia, Malta, Monaco, the Netherlands, New Zealand, Norway, Oman, Portugal, Qatar, the Russian Federation, Saudi Arabia, Singapore, Spain, Sweden, Switzerland, Turkey, United Arab Emirates, the United Kingdom and the United States of America); the European Commission; humanitarian and nongovernmental organizations (including the International Federation of Red Cross and Red Crescent societies) and corporate partners (including Sanofi Pasteur, De Beers, Wyeth). Volunteers in developing countries also play a key role; 20 million have participated in mass immunization campaigns.

Circulation of wild poliovirus: Since 1988, global polio eradication efforts reduced the number of polio cases from 350,000 annually to 1403 in 2006 (as at 10 October 2006), of which 1300 are in the four endemic countries (where poliovirus transmission has never been stopped): Nigeria, India, Afghanistan and Pakistan. This is the lowest number of endemic countries in history.

Funding: In addition to strengthened political ownership in the remaining endemic countries, key to success is the ongoing commitment of the international donor community. For 2006, a further US$50 million is urgently needed, to ensure planned immunization activities through to the rest of the year can proceed. Additional funding of US$390 million is needed for 2007-2008, of which US$100 million is needed for activities in the first half of 2007.

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Source: TIME, Posted Thursday, Sep. 28, 2006

A small group of Muslim clerics is spreading the myth that the vaccine is part of a conspiracy to sterilize Muslims -- and as a result, helping to spread a disease many thought was conquered

It's hard to imagine that anyone could object to a campaign to eliminate polio — a disease that maims, paralyzes, and even kills its victims, who are mostly children. Yet, in one of the more bizarre confrontations between Islamic fundamentalists and the modern world, a tiny group of clerics in India is doing just that — and giving new life to a deadly disease.

Poliomyelitis, a contagious viral disease that once crippled and killed thousands of children annually, has been eliminated in most of the Western world thanks to a vaccine invented by Jonas Salk in the 1950s, but it still survives in some of the world's poorest countries. India seemed to be on the verge of eliminating polio last year, when it reported just 66 cases of the disease, down from 1600 in 2002. This year, however, things have gone horribly wrong with India's polio elimination campaign; 325 cases have been reported already, and at least 23 of them have been fatal. What's caught people's attention is that 70% of those infected with polio this year are Muslim, even though Muslims account for only 13% of India's population. What's even stranger, and frightening, is the reason: some Muslims believe that the polio drops are part of a conspiracy to sterilize their children, and are refusing to let them be vaccinated.

This year's polio outbreak has been concentrated in India's largest state, Uttar Pradesh, home to over 170 million people. It is here, say health workers, that a few ultraconservative Muslim clerics have spread a myth that the polio vaccine is part of an underhanded campaign to sterilize Muslim children and lower the Muslim birth rate. Dr Hamid Jafari, the regional advisor for the World Health Organization (WHO) on polio eradication, says that the majority of Uttar Pradesh's Muslims have got their children vaccinated, but, "in certain places, fatwas have been issued against the vaccine." In those places, Muslims have stopped state health workers from entering their houses and administering the polio vaccine, which is administered orally, to their children.

Dr. Jafari adds that paranoia is not the only reason for the hostility to the polio drops. Uttar Pradesh is notorious for being one of the worst-administered regions of India, and most of the state has appallingly bad hospitals and health services. Muslims, who are among the poorest of Indians, bear the brunt of this collapse in the state's health infrastructure. Dr Jafari says: "There's a sense of frustration among many Muslims: they tell the health workers, we've never seen anyone coming to take care of us, why are you coming just to give us polio drops?"

The result: India's health officials estimated recently that up to 15% of households with children in the western part of Uttar Pradesh state may have been skipped in recent vaccination drives. In a state with a very high population density and poor sanitation, that figure is large enough to ensure that polio — which spreads through contaminated water and contact with excrement — has made a comeback, just when it looked like the net was closing on it in India. Although 90% of India's districts are polio-free, the disease has spread out this year from its epicenter in western Uttar Pradesh to other parts. In March, sewage samples in three slum areas of Bombay, India's financial capital, found polio virus strains in the water. Earlier this week, a nine-year old Bombay girl was found to have got the polio virus, the first case in two years in the city.

Even more disturbing are the global implications of such paranoia. Dr. Jafari says that genetic analysis shows that the strain of polio from Uttar Pradesh, in the past couple of years, has left India, and spread to at least three African countries that had made great strides against polio — Angola, Namibia, and the Democratic Republic of the Congo. This year, he says, the Uttar Pradesh strain of the polio virus has leapt out of India and reinfected two polio-free neighboring countries: Bangladesh and Nepal. "This shows that the continuation of polio in one country is a threat to all the world," he says.

Some countries are taking the renewed threat of polio very seriously. Last year, Saudi Arabia announced that all travelers from countries with polio, under the age of 15, would have to show valid proofs of vaccination before they got a visa to enter the country. India's health minister, Anbumani Ramadoss, stung by criticism, announced recently that that he will step up his government's efforts to eliminate polio in the country — and make a special effort to reach out to India's Muslims. "We are going to have a special program to enlighten them," he told the press recently, adding he would be meeting Islamic leaders in Uttar Pradesh to figure out how he could dispel Muslim anxieties about the polio vaccine. Unless he can, many more parents in India, and throughout the world, will start grappling with their own worries about a disease they thought had been conquered.


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