Washington — The world’s most far-reaching health campaign will be celebrated October 24 for its success in making the world free of polio — almost. On World Polio Day 2011, the number of polio cases has been reduced by 99 percent since 1988 and the disease limited to a handful of countries resulting in fewer than 500 individual cases this year.
For the families who suffer the crippling disease, those numbers do not heal. But in the international health community, where the battle against polio has been waged for decades, those numbers mean the suffering is greatly lessened, and that there is still hope for eradicating the disease.
Major donor nations and health and civic organizations organized the Global Polio Eradication Initiative (GPEI) in 1988 when polio virus circulated in about 125 countries. Today, there are only four countries where poliovirus circulation has never been interrupted in the population: Afghanistan, India, Nigeria and Pakistan.
India, however, a country of 1.2 billion people, has reported only one case in 2011 — that one in January — and no other cases to date.
“This is just tremendous news for India,” said Dr. Paul Chenoweth at the Center for Global Health, part of the U.S. Centers for Disease Control and Prevention. “It’s also tremendous news for the program, and tremendous news for anyone who doubts that polio eradication can be achieved.”
There have been doubts. The initial goal for eradication was 2000, but the virus remained endemic in 10 countries at that time, and the virus reappeared in other countries that thought they had beaten polio. Slippage of that deadline triggered a re-examination of goals, methods and targets; Chenoweth says 2010 saw victories in 15 countries where the virus had reappeared.
“All 15 of those countries stopped circulation of the virus that got into their countries in 2009,” he said in a telephone interview from CDC headquarters.
In three countries previously thought polio-free — Angola, Chad and the Democratic Republic of the Congo — the virus has reestablished itself, according to the world survey of the disease issued by the World Health Organization (WHO). Sudan has managed to tamp down a re-established virus, and rejoins the list of polio-free countries.
In this complex scorecard of countries versus virus, India remains the standout, CDC’s Chenoweth said. “India has to be one of the very, very best programs out there.”
One of the four key strategies of the eradication initiative has been holding events called National Immunization Days (NID). On these occasions, GPEI, ministries of health, local clinics and legions of volunteers conduct massive campaigns to take vaccinations to every child they can reach. In India, Chenoweth said, as many as 170 million children have received protection from polio from an NID event conducted over several days.
Indian physician Kanwaljit Singh described his journey carrying vaccine to a remote village in Bihar state on an NID several years ago. He found himself “crossing two branches of the Kosi river by boat, walking across flooded plains for 15 kilometers and crossing by foot three small tributaries where water levels ranged from knee high to chest high for a six-footer [1.8 meters] like me!”
Not only have the Indians been dogged in their determination to deliver vaccine to every child who can be found, CDC spokesperson Alan Janssen said, they have been creative in the ideas they’ve considered for immunization. Vaccinating on trains and at border crossings and reaching out to nomad populations are some of the Indians’ actions to maximize immunization coverage. “It’s this type of commitment and innovation that has helped India to be successful in their polio vaccination efforts,” Janssen said.
Chenoweth said new ideas like these are necessary to close the final gap to eradication of the disease. The use of GPS mapping techniques to document the routes vaccination teams follow through rural villages is being considered, he said. Satellite surveillance of remote locations might reveal clusters of households where children still need to be reached.
A new vaccine has been deployed in recent years, Chenoweth said, one that is able to protect against the different types of polio circulating in a given region. Experts hope this step may also bring a new advantage to the effort.
Afghanistan and Pakistan remain on the short list of countries that have never quite controlled polio. Both report cases of the disease this year, and Pakistan has the most cases in 2011 of any country. The two central Asian nations are undertaking a major immunization event for World Polio Day; Chenoweth said it should reach 40 million children.
With all the challenges and short-term setbacks, Chenoweth is not disheartened. He remains confident that polio eradication is possible. “We would not be here if we did not believe it was achievable,” he said.
Chenoweth draws inspiration from the support that polio eradication has won from high-level national figures who gather at events such as the World Health Assembly and meetings of the Group of 8 (G8).
But regular people delivering vaccines drop by drop deserve great credit as well. Through the more than 20 years of the eradication initiative, some 20 million average citizens have volunteered to travel everywhere, from urban slums to remote villages, to ensure vaccines reach every child.