Polio eradication efforts need money and political commitment

Burnet Institute

28 May, 2013

A polio vaccination team in Nigeria. Photo courtesy of the Global Polio Eradication Initiative.

Burnet Institute Deputy-Director, Professor Mike Toole wrote this piece for The Conversation, about the challenges in eradicating polio, ahead of philanthropist Bill Gates' visit to Australia.

Global health campaigner Bill Gates is in Sydney today to lobby Prime Minister Julia Gillard to spend more money on global health, particularly the fight against malaria and polio. But while money may indeed further efforts toward malaria’s eradication, the case of polio is a bit more complicated.

The killing of more than 20 polio vaccinators in Pakistan and Nigeria during the past six months has signalled a potentially crippling setback to global efforts to eradicate polio. Only a high level of political commitment to ensure health workers remain safe will enable the program to succeed.

Commonly known as polio, poliomyelitis can kill or cause lifelong paralysis. The highly infectious virus that invades the nervous system mainly affects children under the age of three.

The global polio eradication initiative launched in 1988 is extremely close to victory. When the initiative began in 1988, the illness paralysed or killed 350,000 people, mainly children, every year. Last year, there were just 223 cases worldwide (less than 0.1% of the 1988 caseload).

All but six of these were in the three countries where polio is endemic, meaning that they have never managed to interrupt polio transmission – Afghanistan, Pakistan, and Nigeria. (The other three cases were in Chad, Niger, and the Democratic Republic of Congo.)

All but three

We have the tools to eradicate the polio virus. Most countries have done so through the routine vaccination of children with three doses of an oral vaccine. This effectively builds immunity to all three strains of the virus.

What’s more, new vaccines were developed against specific virus types that helped children build immunity in areas where water quality, sanitation, and hygiene are poor. And where the bacteria that infect their gut interfere with the body’s ability to mount an effective immune response to the traditional vaccine.

This was the case in the last reservoirs of polio in India – the impoverished and densely populated districts of Bihar and Uttar Pradesh.

Along with a major campaign by the Indian government to improve water and sanitation and a mass communications strategy that effectively mobilised communities to vaccinate their children, these new vaccines helped India to finally eradicate polio in 2011.

In Afghanistan, Pakistan, and Nigeria, the two major obstacles are insecurity due to armed insurgencies and misinformation about the vaccine leading parents to refuse to have their children vaccinated.

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Professor Michael Toole AM

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