Global polio eradication: what has been done and what should be done now?

Polio is a horrible disease that has  paralysed so many children worldwide. Now we’re heading towards eradication. Here’s the timeline and the plan.

Polio is a horrible disease that has  paralysed so many children worldwide. Now we’re heading towards eradication. Here’s the timeline and the plan.

polio eradication

Polio timeline towards global eradication
《 Click to see polio endemic countries and timeline.

11 August, which was last week, marked one year without any new polio case in African continent. So, is Africa free of polio? Well not so fast. It’s too early to bring the subject to a close.

Since World Health Assembly launched Global Polio Eradication Initiative(GPEI) in 1988, the number of polio-endemic countries dropped from 125 to 3 countries to this day, namely Nigeria, Afghanistan, and Pakistan. Has the progress been fast enough? The answer is no. It could’ve been faster and it should have. The initiative called for a total wipe-out of the disease by year 2000. Still 20 countries remained polio-endemic at the targeted date.

Even though it’s only 3 countries that are affected at this moment, poliovirus can break out anytime in now polio-free countries under the existence of poliovirus somewhere in the world. It can be imported from an infected country or be derived from the live virus from the vaccine in rare cases. The complete eradication followed by post-eradication effort can only stop the outbreak ever.

GPEI has developed the polio eradication and endgame strategic plan 2013-2018. The nice chart below is the timeline of the plan I retrieved from GPEI. The terms might be confusing, but stick with me I’ll explain.

First objective is to detect the wild polio and to interrupt. With this step wild poliovirus is expected to be lastly reported by the end of 2014. Upon the last case of wild polio, controlling cVDPVs(circulating vaccine-derived poliovirus, meaning paralysed cases from vaccines) case will be focused. Objective 2 calls for a withdrawal of OPV(Oral Polio Vaccine: weakened virus vaccine) and a wider introduction of IPV(Inactivated Polio Vaccine: killed virus vaccine). IPV is also called Sabin’s vaccine which costs more than OPV but it carries no risk of vaccine-derived polio case. Hence, the goal is to eventually end the use of OPV(bivalent OPV, to be exact) in 2019-2020.
Identifying risks is as important as carrying out the right implementation in the right place at the right time. Unexpected factors and external risks can be critical as it can compromise the outcome at its cost. I can think of 3 things for that matter.
  1. A break of war or social disruption. In 2013, Syrian crisis has displaced a large number of people and disrupted health programmes. Not only did it make the virus control difficult, it also allowed the virus to spread and reappear. Natural disaster could factor as well.
  2. Insufficient supply of appropriate vaccine or delay in distribution. Polio vaccine is fragile. In 2010, volcano in Iceland erupted. Among the grounded cargo due to cloud of ashes were 15 million doses of vaccine bound for West Africa. The risk was the fragility of the vaccine and the spread of the disease caused by the delay.
  3. Insufficient fund. The total amount of money that the 2013-2018 strategic plan requires is $5.5 billion. The contribution as of 2014 was $2 billion, which makes the funding gap of $3.5 billion. But the funding gap can be as low as $494 million if all the projection meets the demand.

For meeting each milestone and eventually achieving the goal, the role of governments in both polio-endemic and polio-free countries is crucial. Strengthening routine immunisation along with reliable surveillance all should be guided and well-maintained by national governments as well as independent bodies that monitor and advise on activities. With the effort, the number of infected countries fell to 3. But it’s not just about number 3. A number of potential cases of children paralysed by the virus can be prevented by the complete eradication. All the effort is worthwhile.

Reference:
Polio Eradication & Endgame Strategic Plan 2013 – 2018
Global Polio Eradication Initiative
WHO

 

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Author: Choyoung

An anthropology novice with passion for small things. A development worker in a world of imponderabilia.

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