Polio pushed to lowest levels in history - But experts warn opportunity to stamp out disease must be grasped now due to unstable global situation
16 April 2002 - With only 537 polio cases reported globally in 2001, efforts to eradicate the disease have driven the incidence of polio to its lowest point in history. However the expert panel overseeing the initiative warns that given the current prevalence of conflict, the last vestiges of polio must be extinguished now, as any delay will jeopardize the success of the entire effort.
"When we began the eradication effort in 1988, polio paralysed more than 1000 children each day. In 2001, there were far fewer than 1000 cases for the entire year," said Dr Gro Harlem Brundtland, the Director-General of the World Health Organization. "But we’re not finished yet and the past year has reminded us that we live in a world where security and access to children cannot be guaranteed. So I urge the world to finish the job. Eradicate polio while we still have the opportunity."
From 2000 to 2001, efforts of the Global Polio Eradication Initiative, spearheaded by the World Health Organization, Rotary International, US Centers for Disease Control and Prevention and UNICEF, have reduced the number of polio-endemic countries from 20 to 10. The number of new cases globally was slashed by more than 80%, from 2979 in 2000 to 537 in 2001.* This represents a greater than 99.8% reduction since 1988, when polio paralysed more than 350 000 children in 125 countries.
The Global Polio Eradication Technical Consultative Group (TCG), which completed its annual review of the programme last week, noted that the three zones with the highest poliovirus transmission - northern India, Afghanistan/Pakistan, and Nigeria/Niger continue to pose the greatest risk to the programme. However, the TCG also warned that despite progress in the conflict-affected areas, polio eradication could become a victim to recent global events. The TCG noted, for example, that Afghanistan’s polio surveillance system had suffered over the last few months.
"The re-establishment of an effective polio eradication programme in Afghanistan should be a global priority; all partners, including all UN agencies and the provisional government there, must ensure the job of eradicating polio from Afghanistan is completed and that regional and global progress are not threatened," the TCG stated.
The ten remaining endemic countries, in order of highest to lowest transmission, are : India, Pakistan, Nigeria, Afghanistan, Niger, Somalia, Egypt, Angola, Ethiopia and Sudan.**
"Each of these countries has made tremendous progress, but each has its own unique set of challenges," said Carol Bellamy, Executive Director of UNICEF (United Nations Children’s Fund). "Throughout the battle to rid the world of polio, we have managed to reach children living is some of the most remote and challenging circumstances imaginable. Over the coming days and months, we must continue this unprecedented effort, using all of our resources to reach the very last child with polio vaccine. We now have a unique opportunity to deliver a truly global victory in an uncertain world. We owe it to our children to get the job done."
Countries which appear to have recently stopped transmission include former ‘global poliovirus reservoirs’ Bangladesh and the Democratic Republic of the Congo, where wild poliovirus has not been isolated for well over a year. DR Congo, despite the ongoing conflict, has immunized over 11 million children in national immunization days and rapidly improved surveillance, resulting in a reduction in the number of confirmed cases from 603 to zero in just 12 months.
In 2001 more than 575 million children under five years of age were vaccinated in 94 countries as part of the global effort to eradicate polio. Vaccinators, numbering over 10 million, went house-to-house, boat-to-boat, across borders, through rivers and over mountain ranges to find and immunize every child under five years of age, often in internationally-coordinated immunization activities.
With the end-2002 target for stopping polio transmission worldwide looming, successful National Immunization Days this spring will be essential. Several of the remaining endemic countries (Afghanistan, Pakistan, Nigeria, India, Somalia, Sudan) are undertaking mass immunization campaigns this week, as part of their final push to eliminate the virus.
"The message from the TCG was that we have all the right strategies and tools to exterminate this virus. We know the exact locations, ages, and even the names of almost every child who was stricken by polio last year. In other words, we know the areas where we have to do the hardest work," said Dr Steven Cochi, Director of the Global Immunization Division of the US Centers for Disease Control and Prevention.
Finishing the job requires more funding
Despite the challenges in these remaining countries, the TCG found that the greatest threat to the eradication initiative is now the funding gap. Substantial donations from Canada, the Netherlands, Japan, the United States, the United Kingdom and others have helped reduce the funding gap from US$ 400 million to US$ 275 million over the past year. Of the US$1 billion required for the programme between 2002-2005, US$ 725 million have been pledged or are projected.
Rotary International helped to spark this global movement when it launched its first fundraising drive in 1985 with the goal of immunizing every child throughout the world against polio by its 100th anniversary in 2005. "Now that we are approaching our goal, we need just US$ 275 million to finish the job," said Luis Vicente Giay, Chairman of The Rotary Foundation of Rotary International. "If we raise this money now, we will be saving all of humankind from this disease for all time, and that’s priceless."
Since 1985, Rotary International has contributed US$ 462 million to polio eradication. The non-profit, humanitarian service organization, with 1.2 million members in 163 countries, is launching its second major fundraising drive among its membership to raise an additional US$ 80 million. Rotary will also continue its advocacy work, which has helped raise approximately US$ 1 billion from donor governments and additional funds from the private sector in cooperation with the United Nations Foundation.
Poliomyelitis (polio) is a highly infectious disease caused by a virus that mainly affects children under five years of age. 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). Amongst those paralysed, 5%-10% die when their breathing muscles become immobilized.
There is no cure for polio, it can only be prevented. Polio vaccine, given multiple times, can protect a child for life.
The polio eradication coalition includes governments of countries affected by polio; private foundations (e.g. United Nations Foundation, Bill & Melinda Gates Foundation); development banks (e.g. World Bank); donor governments (e.g. Australia, Austria, Belgium, Canada, Denmark, Finland, Germany, Ireland, Italy, Japan, Luxembourg, the Netherlands, Norway, the United States of America and the United Kingdom); the European Commission; humanitarian and nongovernmental organizations (e.g. the International Red Cross and Red Crescent societies) and corporate partners (e.g. Aventis Pasteur, De Beers). Volunteers in developing countries also play a key role; 10 million have participated in mass immunization campaigns.
*Data as of 11 April, 2002. The World Health Organization estimates 600 cases globally once all data is compiled.**See www.polioeradication.org for details on incidence of polio in each country.
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