Polio: a war not yet won

Brian Cathcart
12 May 2005

One day it could rank among the greatest collaborative achievements of humankind, the fruit of decades of work by millions of people across the globe, at a cost of billions of dollars – but today, with triumph almost in sight, it may be in jeopardy. The campaign to rid the world of polio is suddenly on the defensive, with the virus popping up in countries previously thought clean and the flow of money to fund immunisations running dry.

Only a few years ago there were hopes that this year, 2005, would see the final case, the very last of all the many millions of children to be crippled or killed by this virus down the centuries. But instead the number of countries where people are catching polio has doubled to twelve and just this month a fresh pocket of infection turned up in Indonesia, where no one had caught the disease for a decade.

Also in openDemocracy on the globalisation of health and disease:

Robert Walgate, “Curing malaria: all Africa can try this at home” (March 2003)

Robert Walgate, “Sars and poverty – the missing argument” (May 2003)

Donna M Hughes, “The ABC approach to HIV/Aids” (August 2004)

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Proving that sickness, too, is globalised in the modern world, a strain of the virus from northern Nigeria travelled first to Sudan, on to Saudi Arabia and Yemen, and then across the ocean to Java – perhaps carried by migrant workers, perhaps by Muslim pilgrims going to and from Mecca; no one knows.

And just as it becomes clear that the huge effort to immunise millions of young children must be redoubled, the coalition of organisations leading the drive – the World Health Organisation (WHO), Unicef, Rotary International and the Centers for Disease Control and Prevention in the United States – announce that they are $50 million short of the funding they need to carry on the effort past July.

It is a depressing picture, but staff coordinating the Global Polio Eradication Initiative at WHO in Geneva remain stubbornly optimistic that somehow the money can be found and, even if it takes another few years, this disease can be stamped out forever.

“The final phase is proving difficult,” admits WHO spokesman Oliver Rosenbauer, “but people here are not that surprised. We can’t stop people travelling, after all. But we have a sense of hope, mainly because in the endemic areas the news is still positive.”

The endemic areas are Nigeria, Niger, Egypt, Afghanistan, India and Pakistan, the last six countries in the world with a continuous history of the presence of the disease, and in Egypt and Afghanistan no cases have been reported so far this year. In Niger there has been just one.

Along with Pakistan (with six cases), India (fourteen) and Nigeria (fifty-four), these places are the focus of the eradication effort – and effort is the appropriate word. Several times a year in each country an event of almost biblical character takes place.

In India, to take the most dramatic case, 2 million trained people fan out across the land with the aim of knocking on the door of every home in the country, from Kashmir to Kerala and from Rajasthan to Assam. Inside those homes they identify every child below the age of 5 and then, with due approval from family, place on each little tongue two drops of vaccine. The objective is to treat 169 million children in the space of a single week, and – amazingly – they get close. Then a month or so later they repeat the whole process, in the hope that every vulnerable child will have four doses of vaccine.

The infrastructure behind such events is complex and expensive – for example, the vaccine needs to be kept chilled right up to the point of delivery – and then there are regional conflicts and cultural problems to be confronted.

It was a cultural problem, a resistance to immunisation in rural north Nigeria, that caused the global drive to stumble two years ago. Rumours spread that the vaccine was not safe, that it was part of a western plot, that it spread disease, even Aids. Since uptake is always voluntary the programme had to be abandoned temporarily, and in that time the virus spread from Nigeria to half a dozen neighbouring countries, requiring new immunisation campaigns across the whole region. And then came the outbreaks in Sudan (twenty-four cases in the first five months of 2005), Yemen (twenty-two) and now Indonesia (six).

The numbers may appear small, especially when set against the 350,000 fresh polio cases worldwide logged each year as recently as the 1980s, but the response still has to be huge. The authorities in Java, for example, are now preparing an urgent campaign to vaccinate 5.2 million children.

If the staff at WHO are optimistic, it is because the campaigns in India and Pakistan continue to progress well, while in Nigeria things are finally getting back to where they should be. Confidence in the vaccine has been restored and campaigns which a year ago reached only 50% of children are now reaching more than 80%.

As for the money, they have the edgy confidence of knowing that they have always scraped up enough in the past, and so they trust it will happen again. Rotary International, which has donated around $600 million to date, is likely to give more, and the pressure is on rich-country governments in the west and the Islamic world.

Polio is unusually vulnerable to a human attack – the virus affects only humans and the vaccine is effective – and we can realistically foresee it disappearing from the planet forever. But it is not giving up without a fight. For humankind to win requires a rare if not unique combination of worldwide coordination at the highest levels, multi-million-dollar fundraising and personal commitment from millions upon millions of people on the ground. And, as this month’s news shows, it always seems to need one more big push.

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