26 April 2009
Stopping Polio Forever
By Charlene Porter
In the entire history of medicine, only one disease has been eradicated through human efforts. Deadly and disfiguring smallpox was eliminated as a scourge to humankind in 1980. A vaccine made that achievement possible.
Since 1988 a second campaign has been underway to rid the world of a killer disease, and once again a vaccine is the tool that can purge a virus that has caused so much human misery.
The Global Polio Eradication Initiative (GPEI) brings together a vast network of expertise, resources, and volunteers, waging a global campaign against a lethal virus that can paralyze a child or young adult within hours, then lead to death or lifelong disability. The GPEI is considered the largest public health initiative the world has ever known.
The success of this 18-year-old campaign has been steady. Poliomyelitis appeared in 125 countries in the late 1980s; now the virus is endemic—occurs in nature—in only four countries. Twenty years ago about 350,000 people were stricken by polio each year worldwide. At press time, 1,985 polio cases were known to have occurred in 2006.
The 2006 case total reflects vast progress since the 1980s, but it also underscores the importance of diligence in disease eradication. The number of cases in 2006 is higher than the worldwide annual tolls in the early years of the decade, when fewer than 800 annual cases were detected.
Diligence is required from tens of thousands of health workers, volunteers, villagers, and parents, all willing to make sure that every child receives the multiple doses of vaccine required to stop the disease. That’s every child, including those born tomorrow, next month, next year, and the year after that.
Ensuring the protection of every child everywhere is a goal often pursued with the precision and planning of a political or military campaign.
National Immunization Days (NIDs) are events staged in countries remaining at risk for polio. Public health professionals and thousands of volunteers mobilize mountains of supplies and resources and take them to every isolated corner in their countries to make sure that all youngsters under age five swallow the few drops of liquid that can protect them from crippling disease. In 2005, 400 million children were vaccinated in 49 countries during NID events that lasted mere days.
“It is a huge, huge, huge undertaking,” said Deepak Kapur, the National PolioPlus committee chairman for Rotary International in India. Rotary is an international nonprofit service organization that first envisioned the possibility of a polio-free world. Since 1985 the organization has been a partner working with international health organizations, providing the energies and commitment of its 1.2 million members around the world.
“Vaccinators are, by and large, hopeful and determined,” said Dr. Kanwaljit Singh, a medical officer with the Indian National Polio Surveillance Project, who has been involved with the NIDs for more than a decade. “The mood at the immunization booths [set up in public places] is often festive and cheerful, with colorful buntings and banners, and the hustle and bustle of children playing and bringing their younger siblings for vaccination.”
If children are not presented at the booths in the parks and markets, vaccination teams set out on house-to-house surveys to find every child. “It’s quite an exciting experience, and quite a frustrating one at times,” said Kapur. “At times, you’re welcomed, and they’re happy that you’ve traveled all the way, and very grateful that you’ve come in and are there to immunize their children.” But Kapur has also encountered parents who don’t welcome the immunization team, parents who hide their children to avoid the vaccine out of fear it will harm the youngsters.
Those unsubstantiated fears have been sown in many places, but when they occurred in Nigeria in 2003, a setback in the global eradication effort occurred.
“In certain villages, they heard the leadership say [the vaccination] will affect their children,” recalled BusuYi Onabolu, deputy chair for National PolioPlus for Rotary International in Nigeria.
The virus moved swiftly into a vulnerable population that avoided immunization. In 2004 the number of polio cases doubled in Nigeria, and 12 other nations, previously declared polio-free, experienced a reappearance of the disease, which genetically linked to the strain that had been let loose in Nigeria.
Significant negotiation and discussions calmed the fears about the vaccine, Onabolu said, and in August 2004 allowed resumption of massive inoculation campaigns, which are held periodically until today. But Nigeria’s battle against polio ended 2006 with more than 1,000 cases, almost 40 times the number of cases in 2000.
“We are inching forward; we believe that polio eradication will now be in sight in this country,” Onabolu said. “We cannot afford to let all those years go to waste, can we?”
This article is from the March 2007 edition of eJournal USA, “Lifesaving Vaccines.”
