AFRO-NETS> Changing Epidemiology of Polio

[Claudio Schuftan <aviva@netnam.vn>]

Changing Epidemiology of Polio
------------------------------

CHANGING EPIDEMIOLOGY OF POLIO PROMPTS TACTICAL SHIFT IN WORLD'S 
LARGEST PUBLIC HEALTH INITIATIVE

Supplementary Polio Immunization to be Narrowed to Key Countries

Brussels/Geneva/Tokyo/Washington DC, 13 May 2003 - The Global Polio 
Eradication Initiative announced today that leading experts deem an 
unprecedented tactical shift essential in the campaign to free the 
world of polio. Immunization campaigns will be revised in 93 coun-
tries where polio transmission has already been stopped in order to 
commit more resources to the remaining seven polio-endemic countries, 
and six countries considered at high risk of reinfection.

The shift comes in response to the changing epidemiology of the dis-
ease, with polio more geographically contained than ever. Only seven 
countries remain endemic: India, Nigeria, Pakistan, Egypt, Afghani-
stan, Niger, and Somalia (listed from highest to lowest burden of 
disease). Virtually all the world's polio cases (99 per cent) are 
concentrated in just three countries: India, Nigeria and Pakistan.

Throughout the remainder of 2003 and during 2004, the eradication 
campaigns will focus only on the seven endemic countries, along with 
six other countries considered at high risk of polio reinfection - 
Angola, Bangladesh, the Democratic Republic of the Congo, Ethiopia, 
Nepal, and the Sudan.

In 2003, there will be 51 polio immunization campaigns in the 13 tar-
get countries. Additional campaigns will only be conducted as an 
emergency response to importations. By comparison, 93 countries held 
266 campaigns in 2002. This shift in tactics will accelerate the ac-
complishment of global eradication by focusing on the endemic areas 
while protecting the substantial investments that have been made in 
these areas which are now polio-free.

The shift was announced by the core partners of the Global Polio 
Eradication Initiative, spearheaded by the World Health Organization 
(WHO), Rotary International, the US Centers for Disease Control and 
Prevention (CDC), and The United Nations Children's Fund (UNICEF).

The new tactic will shift 297 million additional doses of oral polio 
vaccine into the tightened geographic target zone, along with US$ 35 
million in additional resources in 2003.

"Until we stop transmission of the poliovirus in the seven remaining 
infected countries, children everywhere will remain at risk of con-
tracting this disease," said Dr Gro Harlem Brundtland, Director-
General of WHO. "Concentrating our resources on these strategic coun-
tries is crucial to root out and extinguish the remaining reservoirs 
of wild poliovirus."

The tactical shift was finalized and adopted on 12 May 2003 by the 
Technical Consultative Group on the Global Eradication of Poliomyeli-
tis (TCG), following its deliberations on 24-25 April in Geneva. This 
independent, technical body meets annually to provide strategic over-
sight to the Global Polio Eradication Initiative.

Even within the endemic countries, polio has been restricted to 
highly concentrated areas. In India, for example, the disease is con-
tained primarily to areas of the north, but these pockets of disease 
have proven to be extremely dangerous. Following a cut-back in the 
number of polio immunization campaigns in India last year, the pock-
ets of transmission in northern India caused the largest outbreak in 
recent history, a six-fold increase in new cases, and the re-
establishment of transmission in previously polio-free parts of the 
country.

"The disease can be imported into countries that are polio-free by 
persons infected in polio-endemic countries," said Dr Walter Oren-
stein, Director, National Immunization Program, US Centers for Dis-
ease Control and Prevention, and chairman of the global TCG. Dr Oren-
stein noted that genetic sequencing confirmed that a recent case of 
polio in Lebanon had been imported from India. "That is why stopping 
transmission in the reservoir countries and intensifying surveillance 
in non-endemic countries is so critical. This focused approach is 
precisely the type of action needed to stop polio once and for all."

Protecting the investment that has been made by the international 
community and particularly polio-free areas will require even 
stronger surveillance, combined with a global emergency response 
capacity.

"Basically we're tightening the noose," said Carol Bellamy, Executive 
Director of UNICEF. "Unfortunately, the funding needed to finish the 
job is extremely tight, too." Ms Bellamy said that at the end of 
2002, an additional US$ 275 million were needed to finish the job by 
2005, with US$ 33 million urgently required for 2003 alone. "We need 
that money to make sure this new tactic is fully implemented, and we 
need it now," Ms Bellamy emphasized.

To help narrow the funding gap through 2005, Rotary International 
launched a second major global fundraising drive among its member-
ship, aiming to raise US$ 80 million by June 2003, for activities 
over the next three years. This is in addition to the US$ 500 million 
and countless volunteer hours Rotary members have committed to polio 
eradication since 1985. "The past successes of this initiative have 
been led by a unique sense of hope," said Bill Sergeant, Rotary In-
ternational. "The future successes will be led by the positive part-
nerships that have been forged since the initiative began."

If successful, polio will be the first disease to be eradicated in 
the 21st century, and only the second after smallpox in 1979. Public 
health experts point to the dire circumstances if the eradication 
initiative falters now. Failure to eradicate polio would result in 
the resources invested being wasted, including over US$ 2 billion and 
the work of 20 million volunteers worldwide, international confidence 
in future global public health initiatives being compromised, and the 
number of annual polio cases drastically increasing.

Further information about the Global Polio Eradication Initiative:

* The Global Polio Eradication Initiative is spearheaded by WHO, Ro-
tary International, CDC and UNICEF.

* There are now 209 countries, territories and areas free of polio. 
Since 1988, the Global Polio Eradication Initiative has succeeded in 
reducing the number of polio cases from an annual 350 000 in more 
than 125 countries, to just 1919 in 2002, in seven countries, repre-
senting a more than 99 per cent reduction in annual polio cases. The 
seven remaining polio endemic countries are (from highest to lowest 
burden of disease): India, Nigeria, Pakistan, Egypt, Afghanistan, Ni-
ger, and Somalia. It is the lowest number of polio endemic countries 
in history.

* One of the primary strategies behind the Initiative's success is 
the organization of mass immunization campaigns, known as national 
immunization days (NIDs). Thousands of volunteers and health workers 
systematically fan out across a country to find and immunize every 
child under the age of five years against polio. Typically, such cam-
paigns last between one and eight days and supplement routine immmu-
nization activities of a country. In 2002 alone, more than 500 mil-
lion children were immunized during 266 immunization campaigns in 93 
countries.

* Poliomyelitis is a highly infectious disease caused by a virus that 
mainly affects children under five years of age. It invades the nerv-
ous system and can lead to paralysis within five days of infection. 
The virus enters the body through the mouth and multiplies in the in-
testine. Initial symptoms are fever, fatigue, headache, vomiting, 
stiffness in the neck and pain in the limbs. One in 200 infections 
leads to irreversible paralysis (usually in the legs). Amongst those 
paralysed, 5-10% die when their breathing muscles become immobilized. 
There is no cure for polio; it can only be prevented. Polio vaccine, 
given multiple times, can protect a child for life.

* The polio eradication coalition includes governments of countries 
affected by polio; private foundations (e.g. United Nations Founda-
tion, Bill & Melinda Gates Foundation); development banks (e.g. The 
World Bank); donor governments (e.g. Australia, Austria, Belgium, 
Canada, Denmark, Finland, Germany, Ireland, Italy, Japan, Luxembourg, 
the Netherlands, Norway, the United States of America and the United 
Kingdom); the European Commission; humanitarian and nongovernmental 
organizations (e.g. the International Red Cross and Red Crescent so-
cieties) and corporate partners (e.g. Aventis Pasteur, De Beers). 
Volunteers in developing countries also play a key role; 20 million 
have participated in mass immunization campaigns.

--
Claudio Schuftan
mailto:aviva@netnam.vn
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