Academic journal article Bulletin of the World Health Organization

Global Eradication of Polio: The Case for "Finishing the job"/Eradication De la Poliomyelite a L'echelle Mondiale: Il Faut « Finir le Travail »/Erradicacion Mundial De la Poliomielitis: Argumentos Para « Acabar El Trabajo »

Academic journal article Bulletin of the World Health Organization

Global Eradication of Polio: The Case for "Finishing the job"/Eradication De la Poliomyelite a L'echelle Mondiale: Il Faut « Finir le Travail »/Erradicacion Mundial De la Poliomielitis: Argumentos Para « Acabar El Trabajo »

Article excerpt

Introduction

The reduction of the number of children affected by polio from 1000 per day (1) in 1988 to about 5 per day (2) in 2006 is a no mean feat by any standard. However, the target established by the World Health Assembly (3) called for the eradication of polio by 2000, seven years ago. Globally, more than 10 million volunteers (4) have administered about 10 billion doses of polio vaccine on hundreds of national and subnational immunization days at a cost of US$ 4.5 billion (5,6) since the World Health Assembly resolution of 1988. (3) The initial success of the polio eradication programme was remarkable and many countries and continents were freed from infection and disease; however, the scenario changed between 2002 and 2005, when resurgence and importation occurred in 21 countries. (7) Since this time, success has been elusive and even in 2007 some pockets of wild polio virus (e.g. in Moradabad, India, and in Kano, Nigeria) give eradication experts cause for concern. (8)

The explanation for the outbreaks of polio in 2006 is given by the "four-year cycle"; outbreaks of polio also occurred in 1998 and 2002. It is now clear that polio will not be eradicated in 2007. (8) The number of cases reported globally in 2006 was higher than in any of the previous six years. (9) In 2006, the number of cases reported in India was higher than in any of the previous four years, (2) while the reported number of cases in Afghanistan and Nigeria was the highest in the previous six years. (9) The situation calls for immediate action.

The author searched and reviewed the full text of the available published literature on polio eradication via PubMed and examined Internet sources and the web sites of major international health agencies. In an effort to understand the current strategy for polio eradication and to identify the hurdles involved, the author suggests new approaches based upon current experiences to eradicate polio as soon as possible.

The conventional strategy

The conventional four-pronged strategy has succeeded in eradicating polio from a large part of the world. This strategy involves maintaining high coverage of vaccination with at least three doses of live oral polio vaccine (OPV), providing supplemental rounds of vaccination, establishing an effective mechanism for the surveillance of acute flaccid paralysis (AFP), and house-to-house OPV "mopup" campaigns carried out at the final stage in a limited geographical region.

High-level political advocacy and mass mobilization have been used to optimum benefit in this programme. Simple management tools like nonmonetary incentives were used to a large extent. Polio eradication has been a dynamic programme in which strategies have been frequently adapted and modified to various extents. Supplementary immunization activities, house-to-house activities and enhanced surveillance were later additions to the programme. (10) The administration of monovalent vaccine (which has enhanced efficacy, increasing the chances of seroconversion in immunized children by almost three times), an increased number of supplementary rounds of vaccination and transit strategies (vaccination at transit points, such as railway platforms and national borders) became part of the programme as late as 2005. (11)

The number of countries in which polio is endemic has decreased from 125 countries in 1988 to four countries (Afghanistan, India, Nigeria and Pakistan) in three WHO regions at the present rime. Nine other countries reported importation of polio virus in 2006. (2) There is only one pocket--Moradabad district in Uttar Pradesh, India--that is continuously exporting wild polio virus to other countries. There is a funding deficit of US$ 575 million to meet for 2007-2008. (6) It is clear that sooner or later the world will be able to eradicate polio, but the current rate of progress is very slow and is impeded by many hurdles. New threats still occasionally emerge that require immediate attention and urgent counteractive measures. …

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