HEALTH: WHO prepares to write the final chapter on polio

By Marwaan Macan-Markar Reprint | | Print |

Marwaan Macan-Markar

MEXICO CITY, Jan 5 2000 (IPS) - Optimism is running high at the World Health Organisation (WHO) as it prepares to launch the final stage of a 12-year effort to eradicate poliomyelitis (polio), a disease that targets children and often results in paralysis.

. On Thursday, Dr. Gro Harlem Brundtland, the director-general of the WHO, will head to the Indian capital of New Delhi to spearhead the last phase of this global effort to vaccinate all children for polio by the end of the year. The WHO’s expection of meeting its year 2000 deadline stems from the drastic reduction in the number of polio cases reported since the initiative was launched. From 1988, when nearly 1,000 cases were detected daily, the number of new cases was just 30 a day by 1999. The recent success in immunising children in countries where it is most endemic – mostly in Africa and Asia – has also contributed to this sense of hope, said Jon Liden, Brundtland’s public relations officer. “We have seen from countries like China that it is possible to eradicate the polio virus within 12 months if a country carries out immunisation campaigns of the intensity all the key countries have been doing over the past few months,” he added. The healthier picture emerging from Third World countries over the last five years has brought success within the WHO’s grasp. Five years ago, for instance, there were still polio cases in East Asia and the number of cases in India, the Middle East and parts of Africa were so high that “there were few who believed we could succeed by the deadline,” Liden said. But achievements over the past 18 months have changed that, observed Liden. The WHO’s efforts to rid the planet of polio through a concentrated immunisation campaign commenced in May 1988, following the 41st World Health Assembly. Unanimous support was offered by all WHO member states on that occasion to offer “a gift to the children of the 21st century” by eradicating polio from the world by the end of the year 2000. Over the last 12 years, the Polio Eradication Initiative (PEI) has immunised millions of children under five years of age. By targeting five other vaccine-preventable diseases – diphtheria, whooping cough, tetanus, measles and tuberculosis – the WHO has succeeded in raising the immunisation rate of children in developing countries from less that five percent in 1974 to around 80 percent by the late-1990s. Although polio, an infectious disease caused by a virus, can be contracted by any age group, it most often affects children under three years old. In most cases, the paralysis it causes is irreversible. Until the 1950s, states a WHO report, polio crippled thousands of children every year in industrialised countries. But following the discovery of effective vaccines in the late 1950s and early 1960s, it was brought under control and “practically eliminated as a public health problem” in the developed world. In the Third World, however, the situation was somewhat different. The WHO attributes the lack of similar success there to it taking longer for “polio to be recognised as a major health problem in developing countries.” According to recent estimates, the polio virus still exists in fewer than 50 countries. The 10 with the highest infection levels are Afghanistan, Bangladesh, India and Pakistan in Asia, and Angola, the Democratic Republic of Congo, Ethiopia, Nigeria, Somalia and Sudan in Africa. In 1998, 450 million children were vaccinated against polio during mass campaigns conducted in these regions by the three institutions involved in the campaign – the WHO, the United Nations Children’s Fund (UNICEF) and Rotary International (RI). That figure was up from the estimated 243 million children – about 38 percent of children under age five – who were vaccinated during an immunisation drive from December 1996 to January 1997. But for the PEI to triumph by December this year, it will require close to twice the number of vaccine doses given to children in 1998. During an appeal last year to mark World Disability Day, Brundtland estimated that an “additional 700 million polio vaccine doses (were) still needed.” According to Liden, in key countries like India, Pakistan and Nigeria, for instance, mass vaccination campaigns would have to “go from a 90 percent success rate to 100 percent.” The WHO has been assured by the Indian government, for one, that it will commit much-needed resources to the accelerated immunisation efforts scheduled for this year. The WHO has also been guaranteed crucial funding for its final push against polio by two foundations in the United States, the Bill and Melinda Gates Foundation and the R.E. (Ted) Turner’s United Nations Foundation. Announced in early December last year, the combined grants – 50 million dollars from the Gates Foundation and 28 million dollars from the Turner Foundation – will be used to “strengthen the vaccine delivery infrastructure and to track the remaining pockets of the disease.” Among the remaining hurdles, however, is “gaining access to difficult areas” and attracting children to the vaccination booths who live in rural and urban areas of the Third World where poverty and illiteracy are high. According to Dr. Jon Andrus, who has worked in New Delhi for six years for the U.S. Centres for Disease Control and Prevention, recent immunisation campaigns in the area have not resulted in only limited success. “A lot of kids (were) being missed. This is a very high-risk area; if they miss this and get 100 percent of the rest of Delhi, this will remain a reservoir of polio, and it could spread the infection back into the city,” Dr. Andrus told a U.S. newspaper. WHO officials involved in the eradication programme have taken note of his warning, and say that greater vigilance will be required. Harry Hull, a pediatrician and epidemiologist who is the senior advisor to the programme, puts it this way: the goal of stopping transmission of the virus by the end of 2000 will be “tough…(but) not impossibly tough.”