The new Polio Eradication and Endgame Strategic Plan, released on April 11, 2013 and developed by the Global Polio Eradication Initiative, has committed signatories to eradicate polio by 2018. Over four hundred experts worldwide signed the document. The plan outlines the key strategies that will make eradication finally possible.

Poliovirus can be spread in several ways: direct person-to-person contact, contact with infected mucus or phlegm or contact with infected feces. While about 95 percent of people exposed to and infected by the poliovirus do not develop symptoms, a small percentage of those infected will experience mild, flu-like symptoms, maybe fever, and stiffness in the neck and back. Less than one percent experience a severe infection. The poliovirus invades the nervous system. Severe infections usually result in permanent paralysis, and, if the poliovirus hits the respiratory system, the infection can result in death. There is no cure for polio.

Jonas Salk created a vaccine in 1955. The polio vaccine is part of the routine childhood vaccination schedule currently used in the United States. Children typically receive four doses of the vaccine before entering elementary school. While polio has been eliminated from most parts of the world, it is still endemic in Pakistan, Afghanistan and Nigeria.

The authors of the plan called it a “step forward over previous eradication strategies.” One big change is the scheduled phase out of the oral polio vaccine (OPV) in favor of the inactivated polio vaccine, which is injected (IPV). The OPV has been shown to be more likely to cause polio than the IPV, although the chances of this happening are still extremely small.

The plan also calls for targeted vaccination campaigns (rather than mass vaccination campaigns, targeted campaigns focus on a specific population or group that may be more at risk of infection than others) and a scale-up (or improved infrastructure) of routine vaccination programs. In the future, governments could use the infrastructure developed around routine polio vaccinations to provide other health services, such as better maternal health and other vaccines.

Experts believe the plan improves on past vaccination strategies because it specifically emphasizes the importance of community buy-in and involvement. In the past, suspicion about vaccines and campaign volunteers has been a huge obstacle to getting children vaccinated. Many parents are hesitant to let their children be vaccinated because they do not know how the vaccination works or they think that the children has received too many doses. In Muslim countries, some people are concerned that the vaccines are not compliant with Islamic law.

A few extreme cases of suspicion have resulted in attacks on polio vaccine campaign workers. On 9 April, 2013, a man working to protect campaign volunteers was shot and killed in Pakistan.

This is not the first attack against health workers in vaccine campaigns. A similar situation occurred in Pakistan in December 2012 when five women were killed. In Nigeria, nine women were gunned down in February while working.

Some suspicion about the intentions of vaccine campaigns is not unwarranted. In July 2012, the legitimacy of public health campaigns was seriously threatened when it was revealed that the CIA had used a hepatitis B vaccination campaign as a cover for reconnaissance on Osama bin Laden in Pakistan.

As reported by the New York Times, Dr. Zulfiqar A Bhutta, a vaccine specialist at Aga Khan University in Pakistan, criticized this strategy. “There could hardly have been a more stupid venture, and there was bound to be a backlash, especially for polio.”

To ease this suspicion, the Strategic Plan has called on religious and community leaders to sanction these campaigns. The new generation of campaigns will also be low-profile in order to protect health workers from future attacks.

If the experts behind the Polio Eradication and Endgame Strategic Plan can overcome this resistance from communities, they are poised to finally eradicate polio by 2018. There were only 223 new cases of polio reported in 2012 and have only been sixteen cases so far in 2013. India, a country where polio has historically been endemic, has seen no cases for the past two years.

In a press release for the new polio plan, Dr. David Heymann, the head and senior fellow at the Chatham House Centre on Global Health Security, explained, “Eradicating polio is no longer a question of technical or scientific feasibility. Rather, getting the most effective vaccines to children at risk requires stronger political and societal commitment”

The Global Polio Eradication Initiative team estimates that global eradication will cost $5.5 billion over the next five years. In the past, gaps in funding have slowed campaigns, resulting in lost time and resurging outbreaks. This time, they hope to raise the full amount of money needed before beginning the campaign. Expected donors include Rotary International, the Bill and Melinda Gates Foundation and government aid.

Chuck Woolery, the issues director of the Global Health Council from 1995 to 1997, says polio eradication is worth the cost. “We can pay a little more now or pay a great deal more in economic and human costs later.”

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