PHA-Exchange> POLIO: TACTICAL SHIFT IN WORLD'S LARGEST PUBLIC HEALTH INITIATIVE

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>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 countries
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
disease,
> > with polio more geographically contained than ever. Only seven
countries
> > remain endemic: India, Nigeria, Pakistan, Egypt, Afghanistan,
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
target
> > 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 accomplishment
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
contracting
> > this disease," said Dr Gro Harlem Brundtland, Director-General of
WHO.
> > "Concentrating our resources on these strategic countries 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
Poliomyelitis
> > (TCG), following its deliberations on 24-25 April in Geneva.  This
> > independent, technical body meets annually to provide strategic
oversight
> > 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
contained
> > 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 pockets 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 Orenstein,
Director,
> > National Immunization Program, US Centers for Disease Control and
> > Prevention, and chairman of the global TCG.  Dr Orenstein 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 membership,
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 International.  "The future
successes
> > will be led by the positive partnerships 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,
> > Rotary 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, representing 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, Niger, 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
campaigns last
> > between one and eight days and supplement routine immmunization
activities
> > of a country. In 2002 alone, more than 500 million 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
nervous
> > system and can lead to paralysis within five days of infection. The
virus
> > enters the body through the mouth and multiplies in the intestine.
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
Foundation,
> > 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 societies) 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.