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lp_progresssheet_polio_final

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									PR O G R ES S S H EE T




The global fight against polio is one of the largest, most ambitious internationally
coordinated health initiatives in history. It has mobilized millions of volunteers around
the world, staged mass immunization campaigns of unprecedented size, and helped
strengthen the health systems of low-income countries. Today, polio eradication is
within reach, but we must remain vigilant.

The global response to polio represents one of the greatest          Rotary International deserves special mention as a key partner
achievements in global health in recent decades. Estimates           in polio eradication efforts, having played key roles through
suggest that 350,000 children were paralyzed by the poliovirus       advocacy, donating funds and mobilizing volunteers. Rotary
in 1988.1 Since then, the Global Polio Eradication Initiative        launched its PolioPlus program in 1985 and has been driving
(GPEI) has shown that a strong global commitment combined            the vision of a polio-free world ever since. More than one
with an unprecedented, internationally coordinated effort has        million Rotary members have volunteered in the field during
the potential to create greater health equity and attainment         NIDs. Rotary has also played an important advocacy role by
of an enormous public health success: the eradication of a           leveraging its political access and its grass-roots networks
devastating disease. Since 1988, about 2.5 billion children have     to directly engage policymakers. To date, Rotarians have
been vaccinated against polio worldwide. In the same period,         contributed $900 million (U.S.) to polio eradication.
the global number of polio cases has been reduced by more
                                                                     The fight against polio has reaped important dividends for
than 99 percent.
                                                                     global health. Implementing polio eradication strategies,
                                                                     including routine immunization, surveillance, NIDs, and
Global Progress                                                      “mop-ups,4 has contributed to building up countries’ health
The fight against polio constitutes one of the largest globally      systems and galvanizing high-level political support by scaling
coordinated health initiatives in history.2 It was launched by       up advocacy and resource mobilization. The initiative has also
the World Health Assembly in 1988 to free the world from             invigorated research and product development activities.5
polio, and is spearheaded by national governments, the
World Health Organization (WHO), Rotary International,               Innovation and Scientific Advances
the U.S. Centers for Disease Control and Prevention (CDC),
                                                                     The development of vaccines that effectively protect against
and the United Nations Children’s Fund (UNICEF). The
                                                                     polio was a major medical breakthrough in the 20th century:
effort to eradicate polio has mobilized more than 20 million
volunteers in 200 countries, who have helped conduct mass            •   The first inactivated polio vaccine (IPV) was licensed in
immunization campaigns, known as National Immunization                   1955, followed by a live orally administered vaccine against
Days (NIDs), of unprecedented size.                                      polio (OPV) in 1961. Administered multiple times, the OPV
                                                                         protects a child for life and can interrupt the transmission of
Thanks to extraordinary commitments from the global
                                                                         the poliovirus. Since it can be provided by volunteers, even
community, funding for polio eradication increased
                                                                         in low-resource settings, and is inexpensive, it is the vaccine
dramatically from $10 million (U.S.) in 1988 to $785 million
                                                                         of choice for most national immunization programs, and
(U.S.) in 2010, as the program moved into the more difficult
                                                                         whenever a polio outbreak needs to be contained.6
areas of the world and set up its on-the-ground infrastructure.
An important milestone occurred in 1996, when funding                •   Taking advantage of the eradication of type 2 poliovirus,
increased to $200 million (U.S.) from less than $50 million (U.S.)       a new monovalent OPV was introduced in 2005, which
just one year before, a big part of which came from the United           increases immunity levels against poliovirus type 1 nearly
States government. The G8 countries account for half the                 three times compared to the original OPV that can protect
financing for the GPEI.3                                                 against all three types of poliovirus. This can be especially
                                                                         useful in rural and conflict-affected areas, where reaching


OCTOBER 2010                                                                                                                               1
PR O G R ES S AG AI NST P O L IO



    a child repeatedly is difficult. The        enabled countries to respond more
    release of bivalent OPV in 2009             effectively to polio and other disease           POLIO
    protects against wild polioviruses          outbreaks, such as cholera, avian flu,           ERAdIcATION
    types 1 and 3—the two wild types            and yellow fever.7                               PROGRESS
    currently in circulation—and is likely
                                                •   A groundbreaking achievement
    to accelerate progress towards a                                                                                                              120
                                                    was the mobilization of millions of
    polio-free world, as it simultaneously
                                                    volunteers around the world to fight
    targets more than one type of polio in




                                                                                                                                                           NUMBER Of POlIO ENDEMIC COUNTRIES
                                                    a single disease.                                                                             100
    a single dose.
                                                •   New ground was also broken in
•   Heat-sensitive markers on vaccine                                                                                                             80
                                                    establishing on-the-ground technical
    vials help vaccinators in remote
                                                    support systems. These support
    locations monitor the quality of the
                                                    systems—from epidemiology and                                                                 60
    vaccine. The development of these
                                                    surveillance to management and
    vaccine vial monitors has enabled
                                                    advocacy—are provided by more                                                                 40
    polio vaccination to move beyond
                                                    than 3,300 on-the-ground polio
    the formal cold chain while still
                                                    staff worldwide.8
    maintaining vaccine effectiveness.                                                                                                            20

The global polio initiative has also
                                                •   A global laboratory network,
                                                    consisting of 145 laboratories, allows                                                          0
introduced critical management and
                                                    for the confirmation of suspected            1985        1992          1999          2006
operational innovations, which have
                                                    polio cases. It also supports a global
                                                                                                 Figure adapted from: Aylward, Bruce R. Polio
                                                    polio surveillance system that               eradication: Setting the ‘context’. Presentation to the
                                                    provides weekly case data from every         Global Polio Eradication's Independent Evaluation
                                                                                                 Team, June 2009.
     WHAT IS POLIO?                                 country around the world.

     Poliomyelitis (polio) is a highly
     infectious disease that is caused by       Results                                          number of endemic countries had
     a virus and mainly affects young           Global progress toward polio                     been reduced to four—from 125 in
     children. Eliminated in industrialized     eradication has been remarkable.                 1988.12 Northern Nigeria, northern
     countries, polio has remained a            Today, polio eradication is within reach,        India, and parts of Afghanistan and
     challenge for developing countries,
                                                and if attained, polio would become the          Pakistan are now the only remaining
     particular for the poor, as it spreads
                                                second disease after smallpox to have            areas where endemic transmission of
     among large and dense populations
                                                been successfully eradicated from                the poliovirus has not been stopped.13
     suffering from poor sanitation and
                                                the globe.
     hygiene standards. The poliovirus                                                       •   Polio-free regions: In 1994, the
     is spread from person to person,           •   About 2.5 billion children around the        Americas (36 countries) were certified
     primarily through the fecal-oral route
                                                    globe have been vaccinated against           polio-free, followed by the WHO
     of transmission.19 Most people infected
                                                    polio since 1988.9                           Western Pacific Region (37 countries
     with polio (90 percent) show no signs
                                                                                                 including China) in 2000, and the
     of illness, are never aware of the         •   Global coverage of children with the
     infection, and continue to transmit                                                         WHO European Region (51 countries)
                                                    oral polio vaccine increased from 67
     the virus to others.                                                                        in 2002.14
                                                    percent in 1988 to 83 percent
     There are three types of wild                  in 2008.10                               •   Lives saved: 250,000 polio deaths
     (naturally occurring) poliovirus.20                                                         have been prevented in the 20
     Circulation of wild poliovirus type
                                                •   Dramatically reduced polio
                                                                                                 years since the GPEI was launched
     2 was interrupted globally in 1999.            incidence: In the 20 years following
                                                                                                 in 1988. In addition, more than 5
     The poliovirus can be highly virulent,         the creation of the GPEI, the number
                                                                                                 million people who would have been
     and one in 200 infections leads to             of global polio cases was reduced by
                                                                                                 paralyzed and incapacitated by polio
     irreversible paralysis, mostly in the          more than 99 percent. According to
                                                                                                 without global support have been
     legs. Among those paralyzed, 5 to              WHO estimates, the number of new
     10 percent die when their breathing                                                         protected and are symptom-free.15
                                                    polio cases has declined from 350,000
     muscles become immobilized.                    annually in 1988 to only 1,087 cases     •   Delivery of other critical health
     Young children are at high risk. More          in 2009.11                                   services: Beyond polio, millions
     than 50 percent of all polio cases occur                                                    of lives have been saved through
     in children under the age of 3.21
                                                •   Circulation of wild poliovirus type
                                                                                                 the delivery of other critical health
     There is no cure for polio, but vaccines       2 stopped: The last polio case
                                                                                                 services in the context of polio
     that effectively protect against the           caused by wild poliovirus type 2 was
                                                                                                 immunization campaigns. Millions
     disease were developed in the 1950s            detected in 1999.
                                                                                                 of insecticide-treated bednets (to
     and 1960s.
                                                •   Few endemic areas left: By 2008, the         prevent malaria), vaccines, and


OCTOBER 2010                                                                                                                                                                                   2
PR O G R ES S AG AI NST P O L IO



  vitamin A doses have been delivered                 responsibilities remains a key priority.          outbreak responses are currently
  to people in need.16 The initiative has                                                               ongoing in the region. To safeguard the
                                                      While there has been notable progress
  also significantly contributed to the                                                                 gains of eradication, such outbreaks
                                                      in these countries, more targeted
  reduction of measles cases worldwide                                                                  must be swiftly contained.
                                                      strategies are necessary to interrupt
  by combining mass polio and measles
                                                      transmission. The GPEI has launched an            Sustained political and financial
  immunization campaigns.
                                                      accelerated research agenda to explore            commitment is required to ensure that
                                                      the best operational and technical                the final steps toward eradication can
Moving Forward                                        eradication strategies for each of the            be taken. Stopping the final chains
Translating global and national political             endemic areas. In 2009, an independent            of transmission in the endemic areas
commitment into local ownership                       evaluation was launched to review the             and ending the outbreaks of polio in
and accountability is the single most                 remaining barriers and to create tailor-          previously polio-free areas requires
important step toward ending polio.                   made, area-specific action plans.                 resources. An estimated total of $2.6
In the four countries where wild                                                                        billion (U.S.) is required in external
                                                      Swiftly stopping outbreaks of polio in
poliovirus is endemic and in parts of                                                                   resources between 2009 and 2013, with
                                                      previously polio-free areas is critical.
the world where polio is still paralyzing                                                               a funding gap of $810 million (U.S.) (as
                                                      Between 2003 and 2007, 27 formerly
children, national and local government                                                                 of September 2010).18
                                                      polio-free countries were temporarily
authorities need to take additional                   reinfected with imported poliovirus,
steps and intensify efforts to protect                20 of them as a result of the virus
their children from infection. Ensuring               originating from northern Nigeria.
that social mobilization strategies                   West Africa is experiencing a new
create a greater local demand for                     polio outbreak from Nigeria that has
polio immunization and assuring that                  reinfected eight West African countries
local governments live up to their                    since 2008.17 Aggressive multi-country




cOUNTRY SPOTLIGHT: STOPPING POLIO OUTbREAkS IN SOmALIA                                             22


Conditions in countries in the          large parts of the country. The last     10,000 Somali health workers    where reaching children
midst of civil war or insurgency        polio case was reported in March         and volunteers—including        repeatedly with a vaccine
pose the greatest challenges            2007 in south-central Somalia.           community, religious, and       is uncertain, using this
for polio eradication. Somalia is                                                traditional leaders—                 targeted vaccine proved
                                        A combination of pioneering
a country where transmission                                                     systematically visited                 extremely effective.
                                        approaches was critical to stop-
of the poliovirus was stopped,                                                   every household in
                                        ping the 2005 polio outbreak                                                    Somalia demonstrates
despite widespread conflict, large                                               every village multiple
                                        in Somalia:                                                                     that polio can be
population movements, a de-                                                      times to hand-deliver SOMALIA
                                                                                                                        eradicated everywhere,
stroyed public health infrastructure,   • To ensure rapid detection of           polio vaccines to every
                                                                                                                        even in the most
and a dearth of functioning               new polio cases, WHO’s country         child under age 5. This
                                                                                                                        challenging settings.
government, through the use of            office, as part of the GPEI,           campaign resulted in the
                                                                                                                      Such success stories
innovative approaches tailored            created an informal disease            vaccination of 1.8 million
                                                                                                               help refine the strategies for
to conflict areas. Somalia’s last         surveillance network, with 100         Somali children.
                                                                                                               eradication and the delivery of
case caused by indigenous wild            Somalis across the country
                                                                               • To make the most of each      other health interventions in
poliovirus was reported in 2002.          providing regular reports of any
                                                                                 contact and immunize children conflict-driven countries as
However, in July 2005 Somalia             suspected cases.
                                                                                 within a short period of      well as for underserved and
was re-infected by poliovirus           • After new polio cases were             time, the GPEI used the new   vulnerable communities in
originating in Nigeria, resulting         identified in 2005, surveillance       monovalent oral polio vaccine non-conflict conditions.
in 228 paralyzed children.                was complemented by                    to rapidly boost immunity
Wide-scale response activities            large-scale vaccination                among children. In war-torn
successfully stopped the outbreak         campaigns throughout the               countries such as Somalia,
in spite of the ongoing civil war in      country. Organized by GPEI,




OCTOBER 2010                                                                                                                                       3
PR O G R ES S AG AI NST P O L IO



Endnotes
 1. B. R. Aylward, A. Acharya, S. England, M. Agocs,     10. Global Polio Eradication Initiative, Strategic      19. This means that polioviruses are usually
    J. Linkins, “Global Health Goals: Lessons from           Plan 2004–2008; WHO vaccine-preventable                 transmitted through contaminated water and
    the Worldwide Effort to Eradicate Poliomyelitis,”        diseases monitoring system: http://www.who.             food, or poor cleaning after handling feces.
    Lancet 372 (13 September 2003): 909-914.                 int/vaccines/globalsummary/immunization/                After infection, the virus is shed in feces for
                                                             countryprofileselect.cfm (accessed 05 October           several weeks. During that time, polioviruses
 2. P. Fine, U. Griffiths, “Global Poliomyelitis             2010).                                                  can circulate silently and rapidly, depending on
    Eradication: Status and Implications,” Lancet 369                                                                the level of sanitation, through
    (21 April 2007): 1321–1322.                          11. B. R. Aylward, “Eradicating Polio: Today’s              the community.
                                                             Challenge and Tomorrow’s Legacy,” Annals of
 3. Global Polio Eradication Initiative, Programme of        Tropical Medicine 100, no. 5 (2006): 401–413;       20. Apart from wild polioviruses, there are vaccine-
    Work 2009 and Financial Resource Requirements            Global Polio Eradication Initiative, Annual             derived polio-viruses, which evolve from the
    2009–2013.                                               Report 2008, http://www.polioeradication.org/           oral polio vaccine that, as a live vaccine, carries
                                                             content/publications/AnnualReport2008_ENG.              a small risk of vaccine-derived outbreaks.
 4. Mop-ups are vaccination campaigns that back              pdf; Global Polio Eradication Initiative, Monthly
    up routine immunization and NIDs and focus on            Situation Report, September 2010.                   21. http://www.polioeradication.org/disease.asp
    high-risk areas or where surveillance detects a                                                                  (accessed 16 July 2009).
    rogue virus.                                         12. http://www.polioeradication.org/history.asp
                                                             (accessed 16 July 2009).                            22. See Global Polio Eradication Initiative,
 5. B. R. Aylward, K. A. Hennessey, N. Zagaria, J. M.                                                                “10,000 Health Workers Stop Polio in One of
    Olivé, S. Cochi, “When Is a Disease Eradicable?      13. http://www.polioeradication.org/casecount.asp.          Most Dangerous Places on Earth: Somalia
    100 Years of Lessons Learned,” Am J Public                                                                       Passes Polio-free Landmark,” press release,
    Health 90 (2000): 1515–20; D. L. Heymann, B. R.      14. World Health Organization, Weekly                       http://www.polioeradication.org/content/
    Aylward, “Global Health: Eradicating Polio,” N           epidemiological record, 3 April 2009.                   pressreleases/20080319press.asp.
    Engl J Med 351 (2004): 1275–1277.
                                                         15. http://www.polioeradication.org/poliodonors.
 6. The current OPV price for developing countries           asp (accessed 16 July 2009).
    is 8 cents (U.S.) per dose, which is five times
    lower than that of IPV.                              16. B.R. Aylward, “Effective Vaccine Uptake. Lessons
                                                             learned from the Global Polio Eradication
 7. D. L. Heyman, B. R. Aylward, “Poliomyelitis              Initiative,” Presentation for Second Annual
    Eradication and Pandemic Influenza,” Lancet              Beth Waters Memorial Lecture, organized by
    372 (13 September 2003): 909–914; C. Goudner,            the Global Health Council; C. Kraayenoord,
    “The Progress of the Polio Eradication Initiative:       “The ‘Extra Benefits’ of Polio Eradication,”
    What Prospects for Eradicating Measles?” Health          International Journal of Disability, Development
    Policy and Planning 13, no. 3 (1998): 212–233.           and Education 52, no. 3 (2005): 169–174.

 8. Global Polio Eradication Initiative, Annual          17. Global Polio Eradication Initiative, Monthly
    Report 2008; B. R. Aylward, “Polio Eradication:          Situation Report, July 2009.
    Setting the ‘Context’,” presentation to the GPEI
    Independent Evaluation Team, June 2009.              18. Global Polio Eradication Initiative, Monthly
                                                             Situation Report, September 2010.
 9. http://www.polioeradication.org/history.asp
    (accessed 16 July 2009).




living Proof is about telling the real story of the incredible progress being achieved by people in developing countries, backed by the support of governments
like ours. Investments in global development are achieving real results. They are saving lives, preventing and curing disease, and helping people, communities,
countries escape from poverty for the long term. See the living proof for yourself. www.one.org/livingproof. Original content for this progress sheet was
developed by the Global Health Group at the University of California, San francisco and SEEK Development in Berlin.


OCTOBER 2010                                                                                                                                                               4

								
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