- Polio (poliomyelitis) mainly affects children under 5 years of age.
- One in 200 infections leads to irreversible paralysis. Among those paralysed, 5% to 10% die when their breathing muscles become immobilized.
- Polio cases have decreased by over 99% since 1988, from an
estimated 350 000 cases then, to 406 reported cases in 2013. The reduction is the result of the global effort to eradicate the disease.
- In 2014, only 3 countries (Afghanistan, Nigeria and Pakistan) remain polio-endemic, down from more than 125 in 1988.
- As long as a single child remains infected, children in all countries are at risk of contracting polio. Failure to eradicate polio from these last remaining strongholds could result in as many as 200 000 new cases every year, within 10 years, all over the world.
- In most countries, the global effort has expanded capacities to tackle other infectious diseases by building effective surveillance and immunization systems.
Polio and its symptoms
Polio is a highly infectious disease caused by a virus. It invades the nervous system, and can cause total paralysis in a matter of hours. The virus enters the body through the mouth and multiplies in the intestine. Initial symptoms are fever, fatigue, headache, vomiting, stiffness in the neck and pain in the limbs. One in 200 infections leads to irreversible paralysis (usually in the legs). Among those paralysed, 5% to 10% die when their breathing muscles become immobilized.
People most at risk
Polio mainly affects children under 5 years of age.
There is no cure for polio, it can only be prevented. Polio vaccine, given multiple times, can protect a child for life.
Polio cases have decreased by over 99% since 1988, from an estimated 350 000 cases in more than 125 endemic countries then, to 406 reported cases in 2013. These included only 160 cases in endemic countries; international spread from endemic areas into polio-free areas accounted for the remainder. In 2014, only parts of 3 countries in the world remain endemic for the disease–the smallest geographic area in history. Of the 3 strains of wild poliovirus (type 1, type 2, and type 3), wild poliovirus type 2 was eradicated in 1999 and case numbers of wild poliovirus type 3 are down to the lowest-ever levels with the last case reported in April 2012 from Pakistan.
The Global Polio Eradication Initiative
In 1988, the forty-first World Health Assembly adopted a resolution for the worldwide eradication of polio. It marked the launch of the Global Polio Eradication Initiative (GPEI), spearheaded by national governments, WHO, Rotary International, the US Centers for Disease Control and Prevention (CDC), UNICEF, and supported by key partners including the Bill and Melinda Gates Foundation. This followed the certification of the eradication of smallpox in 1980, progress during the 1980s towards elimination of the poliovirus in the Americas, and Rotary International’s commitment to raise funds to protect all children from the disease.
Overall, since the GPEI was launched, the number of cases has fallen by over 99%. In 2014, only 3 countries in the world remain polio-endemic: Nigeria, Pakistan and Afghanistan.
In 1994, the WHO Region of the Americas was certified polio-free, followed by the WHO Western Pacific Region in 2000 and the WHO European Region in June 2002. On 27 March 2014, the WHO South-East Asia Region was certified polio-free, meaning that transmission of wild poliovirus has been interrupted in this bloc of 11 countries stretching from Indonesia to India. This achievement marks a significant leap forward in global eradication, with 80% of the world’s population now living in certified polio-free regions.
Of the 3 types of wild poliovirus (type 1, type 2 and type 3), type 2 wild poliovirus transmission has been successfully stopped (since 1999).
More than 10 million people are today walking, who would otherwise have been paralysed. An estimated more than 1.5 million childhood deaths have been prevented, through the systematic administration of Vitamin A during polio immunization activities.
Opportunity and risks: an emergency approach
The strategies for polio eradication work when they are fully implemented. This is clearly demonstrated by India’s success in stopping polio in January 2011, in arguably the most technically-challenging place, and polio-free certification of the entire South-East Asia Region of the World Health Organization occurred in March 2014.
However, failure to implement strategic approaches leads to ongoing transmission of the virus. Endemic transmission is continuing in Nigeria, Pakistan and Afghanistan. Failure to stop polio in these last remaining areas could result in as many as 200 000 new cases every year, within 10 years, all over the world.
Recognizing both the epidemiological opportunity and the significant risks of potential failure, the World Health Assembly in May 2012 adopted a resolution declaring the completion of polio eradication a programmatic emergency for global public health and called for the development of a comprehensive polio eradication and endgame strategy through 2018 to secure a lasting polio-free world.
Subsequently, the 3 remaining endemic countries launched national polio emergency action plans, overseen in each case by the respective head of state, and the partner agencies of the GPEI also moved their operations to an emergency footing, working under the auspices of the Global Emergency Action Plan 2012-2013. By the start of 2013, the impact of the emergency approaches is being seen, with the lowest number of reported cases in fewer districts of fewer countries than at any previous time.
Since then, the new Polio Eradication and Endgame Strategic Plan 2013-2018 has been developed, in consultation with polio-affected countries, stakeholders, donors, partners and national and international advisory bodies. The new Plan was presented at a Global Vaccine Summit in Abu Dhabi, United Arab Emirates, at the end of April 2013. It is the first plan to eradicate all types of polio disease simultaneously – both due to wild poliovirus and due to vaccine-derived polioviruses.
Global leaders and individual philanthropists signaled their confidence in the Plan by pledging three-quarters of the Plan’s projected US$5.5 billion cost over the 6 years. They also called upon additional donors to commit upfront the additional US$1.5 billion needed to secure a lasting polio-free world.
Future benefits of polio eradication
Once polio is eradicated, the world can celebrate the delivery of a major global public good that will benefit all people equally, no matter where they live. Economic modelling has found that the eradication of polio would save at least US$ 40–50 billion over the next 20 years, mostly in low-income countries. Most importantly, success will mean that no child will ever again suffer the terrible effects of lifelong polio-paralysis.
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