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Europe achieves historical milestone as Region is declared polio polio-free

Global polio eradication effort needs US$ 275 million to protect this achievement

The historic decision to certify the European Region of the World Health Organization (WHO) polio-free was announced today at a meeting of the European Regional Commission for the Certification of Poliomyelitis Eradication (RCC) in Copenhagen. For some 870 million people living in the Region’s 51 Member States1, this decision is the most important public health milestone of the new millennium.

"This is a tremendous achievement in the global effort to eradicate polio. To get where we are today required the full commitment and cooperation of each of our 51 Member States, the hard work of public health workers in the field and the firm support of international partners in coordination with WHO," declared Dr Marc Danzon, WHO Regional Director for Europe.

The European Region has been free of indigenous poliomyelitis for over three years. Europe’s last case of indigenous wild poliomyelitis occurred in eastern Turkey in 1998, when a two-year-old unvaccinated boy was paralysed by the virus. Poliovirus imported from polio-endemic countries remains a threat. In 2001 alone, there were three polio cases among Roma children in Bulgaria and one non-paralytic case in Georgia – all caused by poliovirus originating on the Indian subcontinent. A decade ago, imported poliovirus paralysed 71 people and caused two deaths in a community in the Netherlands that refused vaccination.

Of the recent importations, Sir Joseph Smith, Chairman of the RCC noted, "We are satisfied that all measures were taken to ensure that wild poliovirus imported into the Region did not lead to ongoing circulation. All evidence confirms that. However," he cautioned, "our work does not stop here. Throughout the European Region, ongoing vaccination and surveillance is vital. The risk of poliovirus being imported into Europe will continue until we eradicate polio globally."

The path to a polio-free European Region began in 1988, following the call of the World Health Assembly to eradicate polio. A partnership was set up, spearheaded by WHO, Rotary International, the US Centers for Disease Control and Prevention (CDC) and UNICEF, to free the world of the disease. Success in Europe was achieved through an unprecedented series of coordinated national immunization campaigns, known as Operation MECACAR, which involved 18 polio-endemic countries and areas in the European and Eastern Mediterranean Regions of WHO2. Sixty million children under five years of age received two extra doses of polio vaccine every year from 1995 to 1998. Since 1997, MECACAR has included special door-to-door mass vaccination in the high-risk areas of these countries. Supplementary vaccination campaigns have continued in the highest-risk countries through to 2002. This synchronization of immunization among neighbouring countries has become a model for eradicating the disease globally.

The independent panel of international public health experts that comprises the RCC has been engaged in the formal polio-free certification process in Europe since 1996. Before certification could be declared, the RCC had to scrutinize surveillance data and the evidence of national certification committees. In addition, it received firm commitments from all ministries of health on maintaining immunization and surveillance. "Excellent surveillance for acute flaccid paralysis is an essential tool in regional certification, and in the global initiative to eradicate polio. It provides the exact location and ages of every child stricken with polio, guiding immediate immunization responses," said Dr David Fleming, Acting Director of CDC. "Sustaining this surveillance will be vital in guarding against the ongoing threat of importation."

In addition to maintaining immunization, surveillance and the ability to respond to imported cases, European countries are now cataloguing all laboratory stocks of poliovirus as part of a global plan to ensure effective containment in a polio-free world. In contrast to smallpox, where absolute containment was the goal, this plan aims for effective containment to minimize the risk of an accidental or intentional reintroduction of wild poliovirus, by handling retained materials under appropriate conditions.

Since the Global Polio Eradication Initiative was launched in 1988, two WHO regions have been certified polio-free: the Americas in 1994 and the Western Pacific in 2000. Polio cases have dropped from an estimated 350 000 in 125 countries in 1988 to just 480 reported cases in only 10 polio-endemic countries in 2001.

"In Europe and elsewhere we have worked to reach children living in some of the most difficult conditions imaginable, including conflict-affected areas," said Philip D. O’Brien, UNICEF Regional Director for Central and Eastern Europe. "This unprecedented effort, which has been rewarded today with European certification, must be continued until we reach all children, everywhere, with polio vaccine."

Achieving global eradication – the best way of minimizing the risk to Europe’s children – will require the filling of a funding gap of US $275 million for work up to 2005. "This is truly an historic achievement," said Rudolf Hörndler, Chairman of European PolioPlus Committee for Rotary International. "Yet as we get closer to reaching our goal of a polio-free world, we must not grow complacent. Our toughest challenges are ahead of us – a US $275 million funding gap remains." As the volunteer arm and the leading private-sector partner in the global effort to eradicate polio, Rotary has contributed over US $14 million to end polio in Europe, and US $462 million worldwide to date. In addition, Rotary members volunteer their time and personal resources to help immunize children during national immunization days. To help the global effort to close the funding gap, Rotary will launch in July its second major fundraising campaign to raise US $80 million by 2003.

About polio

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 every 200 infections leads to irreversible paralysis (usually in the legs). Of 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 several times, can protect a child for life.

The polio eradication coalition includes the governments of countries affected by polio; private foundations (e.g. the United Nations Foundation and the Bill & Melinda Gates Foundation); development banks, such as the World Bank; donor governments (e.g. Australia, Austria, Belgium, Canada, Denmark, Finland, Germany, Ireland, Italy, Japan, Luxembourg, the Netherlands, Norway, the United Kingdom and the United States); the European Commission; humanitarian and nongovernmental organizations (e.g. the International Federation of Red Cross and Red Crescent Societies) and corporate partners (e.g. Aventis Pasteur and De Beers). Volunteers in developing countries also play a key role: 10 million have participated in mass immunization campaigns.

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1/ Member States of the WHO European Region: Albania, Andorra, Armenia, Austria, Azerbaijan, Belarus, Belgium, Bosnia and Herzegovina, Bulgaria, Croatia, Czech Republic, Denmark, Estonia, Finland, France, Georgia, Germany, Greece, Hungary, Iceland, Ireland, Italy, Israel, Kazakhstan, Kyrgyzstan, Latvia, Lithuania, Luxembourg, Malta, Monaco, Netherlands, Norway, Poland, Portugal, Republic of Moldova, Romania, Russian Federation, San Marino, Slovakia, Slovenia, Spain, Sweden, Switzerland, the former Yugoslav Republic of Macedonia, Tajikistan, Turkey, Turkmenistan, Ukraine, United Kingdom, Uzbekistan, Yugoslavia.

2/ WHO European Region: Armenia, Azerbaijan, Georgia, Kazakhstan, Kyrgyzstan, Russian Federation, Tajikistan, Turkey, Turkmenistan, Uzbekistan.WHO Eastern Mediterranean Region: Afghanistan, Iraq, Islamic Republic of Iran, Jordan, Lebanon, Palestinian Self-ruled Areas, Pakistan, Syrian Arab Republic.

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