Polio: Closing in on zero

Last week, a polio outbreak was confirmed in Syria — a setback for polio eradication efforts, which have managed to reduce the number of endemic countries to just three: Afghanistan, Nigeria and Pakistan. But that blow was followed by a boost.

On Monday, leaders gathered at the Rotary Convention in Atlanta, to pledge $1.2 billion toward efforts to end the disease. Together, the Bill & Melinda Gates Foundation and Rotary International have pledged $450 million to end polio over the next three years, building on a partnership that has been key to the success of efforts so far. Polio is now close to becoming the second human disease to be eradicated.

Remarks by Bill Gates — co-chair of the Bill & Melinda Gates Foundation — at the Drop to Zero event pointed to some of the lessons the global health community can learn from this experience.

“More than 16 million people are walking today who would otherwise have been paralyzed by polio,” Gates said. “Yet we all have one big question on our minds. It’s something I think about all the time. Why has it taken so long?”

When the Global Polio Eradication Initiative, a public-private partnership dedicated to ending the virus, was launched in 1988, the goal was to eradicate the disease globally by 2000. There is no cure for polio, which spreads rapidly among children in particular, invading their nervous systems. Initial symptoms include fever, vomiting and pain in the limbs that can quickly turn into paralysis. Polio can only be prevented by immunization, and more than 10 billion doses of the oral vaccine have been delivered by volunteers and frontline health workers since 2000.

Stephen Crane, a member of the Rotary Club of Seattle, Washington, is a polio survivor, who said paralysis from the disease ended his athletic ambitions and self-confidence at the age of 13.
“When I went to Ethiopia to vaccinate young children after an outbreak, I saw how devastating polio still is for survivors without the care and facilities they need,” he said, explaining that he was able to walk for many years before needing a wheelchair, and that high-quality medical care prevented him from having to use an iron lung, a now obsolete ventilator chamber patients had to lie inside in order to breathe. “It was a privilege to be able to protect kids from paralysis,” he said.

Crane is one of the Rotary members who has used recently discovered cases of polio — such as in Syria last week — to highlight how critical sustained vaccinations and surveillance are to success. “Unless and until we get to zero polio cases for three years, it will come back,” he told Devex, referencing the resurgence of polio in Nigeria last year, after a gap of two years.

Rotary's advocacy is aimed at reminding the public — and their elected representatives — that a fully funded effort must continue until eradication is achieved, he said.

“When smallpox was eradicated, visionary Rotarians saw the possibilities for ending polio. When polio is eradicated, it will inspire others to believe that malaria and other diseases can be as well,” Crane said.

At their international conference, Rotarians’ campaigns included a special “Strike Out Polio” celebration at an Atlanta Braves baseball game; a three-kilometer fundraising and awareness-raising walk; and a virtual reality film that allowed viewers to share the experience of a young Indian girl paralyzed by polio. They celebrated their successes: Three decades ago, 40 children were paralyzed by polio every hour; last year, just 37 children in three countries contracted the disease. They also discussed what more is needed to get to zero.

The $1.2 billion in funding commitments announced on Monday is just $300 million short of what global health experts have said is needed to ensure eradication. Pledges included $75 million from Canada; $61.4 million from the European Commission; and $55 million from Japan. The United States remains the largest government funder of the Global Polio Eradication Initiative — something Gates acknowledged in his remarks, before expressing concern about cuts to foreign aid in the U.S. and elsewhere.

“Constant innovation has been key to improving vaccination coverage and reaching more children with the polio vaccine,” said Dr. Anne Schuchat, acting director of the U.S. Centers for Disease Control and Prevention in Atlanta, which is allocating $233 million to polio eradication this year. “The unrelenting commitment and support of these global leaders will help us do just that — and ultimately end this disease for everyone and forever.”

With uncertainty over the U.S. budget in the coming years, it is encouraging to see other donors stepping up their commitments, Rotarians told Devex.

But money isn’t everything. “I think you all know that money, although very critical … [is] only one piece of the story of Rotary’s leadership on polio eradication,” Gates said. Over the past 30 years, “in the face of challenges that no one would have predicted, [Rotary has] kept it on the global agenda.”

Increasingly, the progress that has been made on polio is being used as an example of lessons learned that might apply to other diseases.

During a panel discussion on ending pandemics at this year’s Skoll World Forum, Salman Ahmad, a polio goodwill ambassador for Rotary International, spoke about the experience of closing in on polio in Pakistan — one of the three countries where it is still endemic. Rather than the role of capital, he emphasized the importance of communication, trust and diverse partnerships — highlighting in particular the influence of Junaid Jamshed, a Pakistani musician, who is credited with making polio vaccines more mainstream by referring to them as a “religious duty.”

Similarly, at a recent conference hosted by the Center for Global Action in San Francisco, Michael Callen — an assistant professor at the University of California, San Diego — presented his research on how to develop better incentives for health workers to improve polio vaccination drives in Pakistan. There is a paucity of data — certainly of credible and reliable data — on who has been vaccinated where, he told Devex, adding that better data means better incentives, which means more vaccinations. Last week, he and others gathered at Harvard University to discuss how researchers can become part of the woodwork of health ministries in solving problems such as this.

Getting to zero hasn’t proven easy — nor will it be moving forward, Gates said. “I think we’d all agree this has been harder than any of us expected. The answer has to do with the ambition of the polio eradication program. Eradication means zero cases: All 7.5 billion people on the planet, across all 200 million square miles — and no polio,” he said.

But the news from Syria serves to underline his words of warning: “As quickly as progress is made,” he said, “it can [also] disappear.”

Update, June 13, 2017: This article has been updated to clarify that Michael Callen is an assistant professor at UC San Diego.

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