Why haven’t we ended po­lio?

The Myanmar Times - - News - ILONA KICK­BUSCH STEPHEN MATLIN MICHAELA TOLD news­room@mm­times.com

OC­TO­BER 24 should be a unique day in the his­tory of po­lio. If all goes ac­cord­ing to plan, it will be the last an­nual World Po­lio Day be­fore the dis­ease is erad­i­cated. But now is not the time for cel­e­bra­tion or com­pla­cency; while we know how to elim­i­nate po­lio, we have not yet fin­ished the job.

Con­sider this: In Au­gust 2014, the World Health Or­ga­ni­za­tion de­clared the Ebola cri­sis in West Africa a Pub­lic Health Emer­gency of In­ter­na­tional Con­cern (PHEIC); it lifted that sta­tus in March 2016. In May 2014, the WHO de­clared the in­ter­na­tional spread of wild po­liovirus a Pub­lic Health Emer­gency of In­ter­na­tional Con­cern as well; yet that sta­tus is still ac­tive to­day, leav­ing one to won­der if world lead­ers are pay­ing suf­fi­cient at­ten­tion.

They should be. The con­tin­u­ing po­lio pub­lic health emer­gency is en­dan­ger­ing the suc­cess of the Global Po­lio Erad­i­ca­tion Ini­tia­tive, into which the world has in­vested US$15 bil­lion since it was launched in 1988; and it threat­ens global health gen­er­ally.

For starters, the po­lio erad­i­ca­tion ef­forts at­tempts to in­ter­rupt po­lio virus trans­mis­sion could miss its lat­est tar­get date; un­for­tu­nately, it would not be the first time. By the orig­i­nal 2000 tar­get date, the in­ci­dence of po­lio had been re­duced by more than 99 per­cent, from an es­ti­mated 350,000 cases in 1988. Since then, how­ever, a long, stub­born “tail” of in­fec­tion has per­sisted, mainly in re­mote, poor re­gions and con­flict zones. The ef­fort to tackle these lin­ger­ing cases is la­bo­ri­ous, and it re­mains in­com­plete, de­spite PHEIC sta­tus.

To be sure, there have been some suc­cesses, such as in In­dia, which was cer­ti­fied po­lio-free in 2014, and in Nige­ria, which in­ter­rupted trans­mis­sion the same year. But there have also been set­backs: In 2016, Nige­ria sud­denly had two new cases among chil­dren from an area that had just been lib­er­ated from the mil­i­tant group Boko Haram.

The two other po­lio-en­demic coun­tries, Afghanistan and Pak­istan, missed their 2015 erad­i­ca­tion tar­get and have had to ex­tend it by an­other year, at a cost of $1.5 bil­lion. The root causes of both coun­tries’ missed dead­lines will re­quire del­i­cate, skilled po­lit­i­cal han­dling to re­solve. They in­clude in­ter­nal con­flicts that make chil­dren in­ac­ces­si­ble to pub­lic health pro­fes­sion­als, op­po­si­tion by some re­li­gious lead­ers, and pub­lic mis­trust of na­tional gov­ern­ments and in­ter­na­tional ini­tia­tives.

Erad­i­cat­ing po­lio is ex­pen­sive, but it would cost tens of bil­lions of dol­lars more to fight the dis­ease in per­pe­tu­ity. Politi­cians and pol­i­cy­mak­ers should be re­minded that a po­lio-free world would be a global pub­lic good, that erad­i­ca­tion is by far the best bar­gain, and that sus­tained fi­nanc­ing and po­lit­i­cal sup­port is nec­es­sary to en­sure the po­lio erad­i­ca­tion ef­fort’s suc­cess.

But it is also im­por­tant to en­sure that valu­able as­sets and prac­tices built up by the erad­i­ca­tion ini­tia­tive over time are not squan­dered once po­lio is gone. These in­clude cold chains to pre­serve vac­cines dur­ing trans­port from fac­to­ries to pa­tients; es­tab­lished “im­mu­ni­sa­tion days” and ne­go­ti­ated “days of tran­quil­ity” in con­flict zones, when vac­ci­na­tions can be ad­min­is­tered; trained healthcare work­ers; and sys­tems for surveil­lance, lab­o­ra­tory anal­y­sis, and rapid re­sponse. These as­sets have proved their worth in com­bat­ing other dis­eases: Nige­ria was able to stop Ebola’s spread dur­ing the West Africa out­break ow­ing to its ef­fi­cient po­lio-track­ing sys­tem.

The re­al­ity, how­ever, is that coun­tries will be able to ab­sorb the po­lio erad­i­ca­tion ini­tia­tive’s as­sets into their health sys­tems only if they are sup­ported fi­nan­cially, lo­gis­ti­cally and po­lit­i­cally. A ma­jor ef­fort will be re­quired to trans­fer ma­te­ri­als to where they are needed, and to co­or­di­nate surveil­lance and lab­o­ra­tory oper­a­tions. Do­ing so would not only boost global-health se­cu­rity and re­silience for the next out­break; it would also help us reach the United Na­tion Sus­tain­able De­vel­op­ment Goal for univer­sal healthcare cov­er­age.

More broadly, lessons from the global po­lio erad­i­ca­tion ini­tia­tive and other erad­i­ca­tion ef­forts must not go un­learned. In 1980, small­pox be­came the first dis­ease in peo­ple to be suc­cess­fully erad­i­cated, and there were prior un­suc­cess­ful cam­paigns against hook­worm, yaws, yel­low fever and malaria. But many lessons that were al­ready known by the 1980s went un­heeded for too long – such as the im­por­tance of tack­ling re­mote in­fec­tion reser­voirs and main­tain­ing high im­mu­ni­sa­tion levels ev­ery­where so that health sys­tems aren’t over­whelmed.

A com­plex ar­ray of po­lit­i­cal pres­sures, mo­tives and as­pi­ra­tions de­ter­mines which lessons we take from his­tory and which new global-health tar­gets we set for our­selves. World Po­lio Day is thus an oc­ca­sion to urge politi­cians to re­new their com­mit­ments to po­lio erad­i­ca­tion, and to ap­ply lessons from the erad­i­ca­tion ef­fort to im­prove health ev­ery­where.

In the fight against po­lio, the world is largely re­ly­ing on the gen­eros­ity of the United States, Ro­tary In­ter­na­tional, the Bill & Melinda Gates Foun­da­tion, and Euro­pean coun­tries such as Ger­many, Nor­way, and the United King­dom, with ad­di­tional po­lit­i­cal sup­port from oth­ers such as Monaco. Other Euro­pean coun­tries and the Euro­pean Com­mis­sion it­self should do more to con­trib­ute to the erad­i­ca­tion ef­fort.

While G7 mem­ber states re­newed their com­mit­ment to elim­i­nat­ing po­lio at a sum­mit in Ja­pan ear­lier this year, a sub­se­quent G20 sum­mit in Hangzhou, China, where two-thirds of the world’s pop­u­la­tion was rep­re­sented, made no ref­er­ence to it; nor did the G77 group of 134 de­vel­op­ing coun­tries.

That is not good enough. Af­ter years of ef­fort, it is now clear that only a strong, con­sis­tent, world­wide com­mit­ment to full erad­i­ca­tion can end the po­lio emer­gency. – Project Syn­di­cate

Ilona Kick­busch is direc­tor of the Global Health Cen­ter and a pro­fes­sor at the Grad­u­ate In­sti­tute of In­ter­na­tional and De­vel­op­ment Stud­ies, Geneva. Stephen Matlin is a se­nior fel­low at the Global Health Cen­ter. Michaela Told is ex­ec­u­tive direc­tor of the Global Health Cen­ter.

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