Time for cautious optimism on a polio-free future

By Carlos Santamaria 24 November 2015

Misrak Teshome gets her daughter Elshaday Tadesse vaccinated against polio. Polio eradication is within reach, but vaccination efforts must continue apace to stamp out the disease once and for all. Photo by: UNICEF Ethiopia / CC BY-NC-ND

A quarter of a century ago, Rotary International, the U.S. Centers for Disease Control and Prevention, UNICEF and the World Health Organization set out on a quest to stamp out polio throughout the world.

Today, that goal finally seems within reach. Over the past year, Nigeria has not reported a single new case of wild poliovirus type 1; reported cases in Pakistan have declined by 80 percent since mid-2014; and vaccination teams have managed to reach all but a few remote areas in Afghanistan.

The global health community is optimistic about achieving full, worldwide eradication by 2019, coinciding with the 30th anniversary of the Global Polio Eradication Initiative. For Dr. John Sever, vice chair of Rotary’s International PolioPlus Committee and one of the few remaining original “polio warriors” of the late 1970s, it would mean the realization of a lifetime ambition.

“I’m very pleased and hopeful that we’ll move quickly now in the next year or two to complete the eradication effort. It has certainly moved in that direction, and I’m very grateful that there’s been such strong support,” 82-year-old Sever told Devex.

Hailed as one of the most successful global health programs ever, the $10 billion GPEI has immunized more than 2.5 billion children in over 200 countries around the world since its launch.

Its initial goal was a polio-free world by 2000, but the struggle against the disease turned out much tougher than many thought. Among other challenges, vaccination teams faced strong opposition from religious groups in target countries, with scores of polio workers killed over the past decade.

But the vaccination teams continued, and subsequent progress has been quite remarkable.

“We’ve never seen things this low. We’re closer now than we’ve ever been before,” said Dr. Walt Orenstein, former director of the U.S. National Immunization Program.

Not there yet

While eradication may be on the horizon, experts cautioned that there is still some way to go and warned polio could return if high levels of population immunity are not maintained — even in countries like India that have been declared and certified polio-free.

“The biggest issue now is political will, and overcoming insecurity to be able to deliver vaccines to people in need,” Orenstein told Devex. “We have the tools that we need; it’s a matter of reaching the children that need to be reached.”

In Afghanistan, the two main problems are insecurity and access to areas controlled by myriad anti-government groups. In Pakistan, the challenge is population movement between the cities of Peshawar and Karachi. And in both countries, the strategy is the same: identify villages at risk, travel there and vaccinate the children.

“We’ve been in the business of eradicating polio for over 25 years, and we know what we need to do — getting the basics right [with] high-quality vaccination campaigns in these final few areas,” Dr. Paul Rutter, COO for polio eradication at WHO, the U.N. agency that will ultimately certify that the world is polio-free in the future.

Said Rutter: “We don’t need to do anything fundamentally different, it’s just we are operating in some of the most difficult environments in the world, so we are tailoring those basics.”

Although it may be business-as-usual in terms of implementation, Orenstein reminded stakeholders that there is still much room for improvement on the medical aspects of the vaccination campaigns. For instance, more attention must be paid to the risks of using multitype vaccine viruses, which were previously thought to help deliver the vaccine, but are now known to be able to mutate and take on the properties of wild viruses, thereby rendering the vaccine less effective.

Legacy beyond eradication

Despite the risks, there seems to be an overall consensus among partners that polio eradication is nearing the finishing line. Efforts are underway to report on the legacy of the global initiative, as well as how decades of experience fighting the crippling disease all over the world can help combat other ailments such as malaria or measles.

Global health has definitely learned a lot from the “polio warriors,” said Sever, who mentioned the need to work with all groups at all levels to build — and maintain — trust, gain support for the program and encourage vaccination. It was this, he said, that proved to be a game changer for Rotary International in Nigeria.

A key legacy of the anti-polio campaign there are the emergency operation centers, which brought together all partners to coordinate activities under the leadership of the government and develop strong data analysis capacity. This structure was already in place when the Ebola outbreak was declared in late 2013.

“Many believe it prevented Ebola from spreading across Nigeria and from there to other parts of the continent,” explained Rutter. “The infrastructure was in the right place at the right time, and it’s one of those things we want to ensure continues.”

Vaccination campaigns carried out over such a long period of time and in so many different countries have also provided the polio program with a wealth of lessons learned on the ground that apply to other disease interventions.

A few crosscutting tips from Orenstein included securing buy-in from the political leadership at the highest level; conducting strict surveillance to know who’s getting infected, and why; undertaking ongoing research, including equipment and staff trained to identify the virus; focusing on the outcome measures instead of the process; and always monitoring implementation, because “you can’t assume that just because you ask someone to do something, it will be done.”

“You don’t get what you expect — you get what you inspect,” he said, adding that the ideal global health strategy is one with “policy based on good science, [and] results based on good management.”

Ending a Global Disease is a conversation hosted by Devex, in partnership with Rotary International, to explore successes in the fight against polio and identify lessons that can be applied to overcoming other global diseases. Visit the campaign site and  join the conversation using #endpolio.

About the author

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Carlos Santamaria

Carlos Santamaria is a multimedia journalist and editor based in Manila. A former Devex associate editor, he has over a decade of experience working for international media outlets such as Reuters, Associated Press, Xinhua and EFE in Spain, China, the Philippines, Thailand and the United States, and has covered major crisis situations on the ground in Myanmar and Japan. Carlos is currently an editorial and communications consultant with the Asian Development Bank.

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