Urgent stakeholder consultation on interrupting wild poliovirus transmission
Dr Margaret Chan
Director-General of the World Health Organization
Excellencies, friends, colleagues, ladies and gentlemen. This is my first opportunity as Director-General to address a meeting of stakeholders. You are indeed a distinguished group, as you heard from the list: eminent scientists, committed partners, honourable ministers.
First and foremost, let me thank you for coming to Geneva at such short notice. I personally requested this meeting. I asked that it be held on an urgent basis.
This is a high-level consultation. This is a critical review of the case for finishing polio eradication.
Today may prove to be a watershed event. We have reached a critical point in our drive to eradicate polio. We are in the low season for virus transmission. And I don’t mind sharing with you: we are also at the lowest level of cash flow. Indeed, by April of this year we will experience a negative cash flow. And that is the reality.
If we don’t meet this virus with an immediate surge of commitment, the virus may win. We are facing our best and perhaps our last opportunity to eradicate polio.
I described this as our best opportunity. On one level, the task before us looks more promising than ever before. We need to interrupt endemic transmission of wild poliovirus in limited areas within just four countries and a few other areas that have been reinfected. In this sense, we have the virus cornered as never before.
We have extremely sensitive surveillance in place – arguably the best in public health. We can say, with confidence, that we can now find every chain of virus transmission. We know where we stand.
We have already eradicated one of the three strains of wild polio virus. We have improved monovalent vaccines for targeted immunization. We have new approaches tailored to the epidemiological situation and operational challenges in each of the four remaining countries. We know how to move forward.
But we face serious problems that demand very frank discussion and assessment. We have missed our original deadline. The sceptics have respectfully voiced their views.
Questions have been raised about vaccine efficacy, access, security, poverty, funding, and competing health programmes. We have seen repeatedly how rumours can jeopardize the progress we collectively can make.
But we know where we stand, and how to move forward. Much depends on our ability to move forward in a different way than in the past.
I am speaking to affected countries, and I am happy to see that presidents and prime ministers have sent high-ranking representatives – people who can influence decisions. To be successful, we will have to reach every child in the last remaining areas. To do this, we must have commitment at the highest level of government.
I am speaking to the other spearheading partners: Rotary International, the Centers for Disease Control and Prevention, and UNICEF. You are also represented in this room. Your commitment must not waver.
I am speaking to the Regional Directors of WHO. Within WHO, we have already begun to do things in a different way. We have made polio eradication a top cross-regional priority of the Organization. The presence here of Regional Directors solidifies our strengthened internal collaboration. And this is the different way of doing business at WHO.
And I am speaking to the international donor community. Your commitment is absolutely vital. You will be seeing today new data that show why, over a 20-year period, every proposed option for controlling polio will cost more, in human suffering and dollars, than finishing eradication. In other words, getting the job done is your best buy.
Ladies and gentlemen,
To date, public health has eradicated only one disease – smallpox. Times have changed since then. Global eradication of a virus in a world of more than 6 billion people is not an easy job.
I have been told repeatedly that there are no significant scientific or technical barriers to polio eradication. The problems we face are largely operational and financial.
Countries are tired. Staff are tired. Donors are tired. But I put it to you: we are on the verge of victory. We have in this room the people with the leadership and the power to give us another resounding victory for public health. This is indeed a watershed event.
What is at stake? Let me share with you some of the important data. We have invested more than 18 years in this, and we have invested almost five billion dollars. How will history judge us if we squander that investment? Can we be forgiven for not marshalling the commitment, the funds, and the determination to finish the job?
We know that the eradication effort has been of enormous benefit in shrinking the number of cases of paralytic polio. Cases have dropped dramatically from an estimated 350,000 cases in 1988 to less than 2 thousand last year. This is a very impressive record of performance, but we are not there yet.
We know that the eradication effort has established infrastructures and strategies that have brought huge benefits to other programmes. Let me just give you an example. The measles initiative, which recently not only met its ambitious targets but surpassed them, was largely implemented through the polio infrastructure.
The polio drive has demonstrated that it is possible to achieve very high rates of population coverage despite weak health infrastructures and high levels of poverty. This is an inspiring message for other initiatives, including those aimed at reaching the Millennium Development Goals.
Polio proves that interventions can be scaled up to reach those in greatest need. This is possible because local communities themselves are at the centre of implementation. They, too, are partners with much at stake.
We can cite important and inspiring achievements, and the list can go on. But is this where we should end, so close to our ultimate goal? Are these achievements sufficient?
Let me put it to you. Actually, there is more at stake. Since its inception, the drive to eradicate polio has been an expression of the power of public health partnerships to do great and lasting good. Most of us still have vivid images of what polio means. We remember the iron lungs. We had friends and classmates with crutches or leg braces and crippled limbs.
We have very few opportunities, as an international community, to do something that is unquestionably good for every country in the world. I want to reemphasize the notion of universal vulnerability. If we don’t get the job done, the rest of the world is not safe from polio.
We have few opportunities to change the world for the better in a permanent way. This is an act of solidarity, a sign of our shared responsibility for health.
Polio eradication will be a perpetual gift from us – and from all those in the field – to every future generation of children to be born.
Ladies and gentlemen,
I called for this meeting and I will be personally committed to its outcomes. This is my duty.
As I said, we need to do things differently, and we are doing so within WHO.
Shortly after I took office, I discussed prospects for polio eradication in a meeting with Regional Directors. The view was unanimous and adamant: we must finish the job.
Last week, the Regional Director for Africa brought together representatives from all other WHO regions to map out a joint strategy for eradication as a top, cross-regional priority for WHO.
In a resolution adopted in 1988, WHO member states made a public commitment to eradicate polio. That commitment has been renewed several times since then. We have a clear mandate to eradicate polio. And I have a duty to carry out this mandate given to us by our member states.
We will be reporting the conclusions and recommendations of this meeting to the Health Assembly in May.
As I said, to get the job done, we need to marshal commitment, funds and determination. Let me explain what is meant by determination by repeating a statement made by Rotary International during the Executive Board meeting in January. “Polio eradication can be done, must be done, and will be done.”
Again, I thank all of you for coming and look forward to the outcome of this meeting. Much is at stake – for me personally, for WHO and its multiple partners, for the world, and, of course, for all future generations of children.