The Guardian
As the Asian nation marks three years since the last reported polio case, what lessons can Pakistan, Afghanistan and Nigeria – the three remaining endemic countries – learn?
Today marks a landmark achievement for global public health and the worldwide effort to eradicate polio. India, which once had the highest number of polio cases in the world, is now polio-free, an achievement reports say the World Health Organisation will certify in February.
But it’s been a long road to get here. With poor sanitation, densely populated areas and large numbers of people living in extreme poverty, northern states like Uttar Pradesh and Bihar were the ‘perfect storm’ when it came to the spread of polio. And without the vital collaboration between the Indian government and the global polio eradication initiative – a partnership among Rotary International, Unicef, WHO and the US Centre for Disease Control and Prevention – this may not have been possible.
Long recognised as one of the most difficult places to eradicate polio, India stands as an example for how to mount a successful disease response effort under the most complex circumstances.
When I visited India’s National Polio Surveillance project in Delhi in 2012, I was joined by a delegation of local health officials from Afghanistan. They had come to learn how India had leveraged sophisticated global positioning technology to map the movements of the mobile and migrant population to successfully reach children consistently missed by previous vaccination campaigns. Simple, but effective.
And there are more examples that can prove useful to reaching missed children in other polio-affected countries. For example, India involved religious and community leaders to help build support for vaccination among local families. In cities like Ghaziabad, announcements by local imams in mosques actively encourage congregations to immunise their children, persuading parents to accept the polio vaccine where they otherwise may have resisted.
These lessons learned are now part of the global strategic plan to secure a polio-free world by 2018. At the Global Vaccine Summit in April last year, the global polio eradication initiative announced the new polio eradication and endgame strategic plan 2013-2018. Global donors pledged $4bn (£2.4bn) to support the strategic plan – the first long-term strategy that comprehensively lays out what is needed to cease transmission of wild poliovirus and eradicate polio once and for all.
Now we need the donor community to back this plan. Current commitments of $4bn go a long way, but eradicating polio will require coming up with the remaining $1.5bn needed to fully fund the strategic plan. And while some donors like Canada – the first country to support the polio eradication initiative in 1988 – have shown steadfast support, others need to renew their commitment. In Australia, for instance, the newly elected Abbott government has so far stopped short of reaffirming the $80m contribution announced by the previous government in May 2013.
Ultimately, by capitalising on India’s achievement, we all have a stake in the fight to end polio around the world. This exciting anniversary in India is proof of what is possible when the global community bands together in support of polio eradication. Yet, polio outbreaks in previously polio-free countries – Somalia, Syria, Cameroon – and the presence of the polio virus in Egypt and Israel are constant reminders of the need to act quickly; as long polio remains anywhere, it is a threat everywhere.
What’s more, if we can supply the hardest-to-reach children with the polio vaccine, it will prove that we can also get food, clean water and other health services to them. The evidence is there: in the process of eradicating this debilitating disease, India has improved immunisation and health systems more broadly. It has developed a blueprint for reaching every last child with life-saving interventions, even in remote, socially excluded and marginalised communities. As Dr Bruce Aylward, the assistant director-general in charge of polio eradication at the WHO once said, India’s polio programme has reached “the populations that always get left behind for everything … [they’ve] put a face on the kids that nobody ever sees, the population nobody knows.”
With only three polio-endemic countries left – Pakistan, Afghanistan, and Nigeria – we are the closest the world has been to achieving a polio-free world. With cases reduced by 99% since 1988, we now have the required response strategies, political commitment and engagement. But ending polio comes down to governments, local leaders and agencies continuing to support the work of the thousands of community mobilisers and vaccinators at the frontline of this extraordinary effort.
This article can also be read at:
1.2 billion reasons to celebrate: India set to be polio-free
