Academic journal article Bulletin of the World Health Organization

Disease Eradication as a Public Health Strategy: A Case Study of Poliomyelitis Eradication

Academic journal article Bulletin of the World Health Organization

Disease Eradication as a Public Health Strategy: A Case Study of Poliomyelitis Eradication

Article excerpt

Voir page 293 le resume en francais. En la pagina 294 figura un resumen en espanol.

Introduction

"Elimination and eradication are the ultimate goals of public health, evolving naturally from disease control" (1). Despite the humanitarian and economic rationale behind this statement, a number of commentators continue to question whether the benefits of such initiatives warrant the human and financial costs and the tremendous focused effort required to eradicate a disease. As a result, two major international meetings were convened recently to examine the concept of disease eradication as a public health strategy: a workshop on the eradication of infectious diseases held in Dahlem, Germany, from 16 to 22 March 1997 (2); and a conference on global disease elimination and eradication as public health strategies, held in Atlanta, GA, USA from 23 to 25 February 1998 (3). As a starting point, these meetings sought to define the criteria for targeting a disease for eradication, not only in terms of the biological determinants of eradicability, but also in terms of the costs and benefits, and societal and political considerations (1).

Ten years into the largest disease eradication initiative ever launched, it is both timely and instructive to re-examine the goal of poliomyelitis eradication by the end of the year 2000 in light of the criteria put forward at the Dahlem and Atlanta meetings. Three questions are considered.

* Why eradicate poliomyelitis? (costs and benefits).

* Why is poliomyelitis eradication technically feasible? (biological determinants of eradicability).

* Why is poliomyelitis eradication operationally feasible?' (societal and political considerations).

This article begins by outlining the current status of the eradication initiative and closes with a summary of the major challenges now and in the postpoliomyelitis eradication era.

Current status of the poliomyelitis eradication initiative

The goal of eradicating poliomyelitis by the end of the year 2000 was adopted by the World Health Assembly in 1988 (4). Since then, poliovirus has disappeared rapidly from large areas of the world. At the same time, the capacity to control other important diseases has improved worldwide. The number of poliomyelitis cases has fallen by over 95% around the world, from an estimated 350 000 in 1988 to an estimated maximum of 20 000 in 1999, with the elimination of wild poliovirus from three of the five continents where it was endemic at the outset of the initiative (5).

The western hemisphere was certified as poliomyelitis-free in 1994 (6), and the last case of paralysis due to endemic wild poliovirus in the WHO Western Pacific Region was identified in March 1997. In the WHO European Region, wild poliovirus was last identified in November 1998 in south-east Turkey. By the end of 1999, poliomyelitis had disappeared from much of the eastern Mediterranean area and no virologically confirmed cases had been reported from south and north Africa for more than two years, with the exception of Egypt (5). The geographical extent of the remaining poliovirus circulation continues to shrink. At the end of 1999, wild polioviruses were circulating in a maximum of 30 countries, primarily in sub-Saharan Africa and South Asia (Fig. 1).

[Figure 1 ILLUSTRATION OMITTED]

Details of the four principal strategies that have been central to the success of the poliomyelitis eradication initiative -- strong routine immunization programmes, national immunization days (NIDs), surveillance for acute flaccid paralysis (AFP) and house-to-house "mop-up" operations -- have been described elsewhere (7, 8). The present article focuses on the eradication initiative in the context of the major criteria for such initiatives that were outlined at the Dahlem and Atlanta meetings.

Why eradicate poliomyelitis?

The attractions of disease eradication as a public health strategy are manifold. …

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