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What Will It Take to Protect Children for Generations to Come from a Preventable Disease?

March 13, 2013

Vaccines work to save and improve lives and protect children for a lifetime. They have allowed us to eradicate one disease to date – smallpox in the 1970s, and now we have an opportunity to change history and end a second disease forever – polio. With the development of vaccines in the 1950s and the world committing to eradication in the 1980s, the number of polio cases fell from over 360,000 in 1988 to less than 250 in 2012. That’s the fewest number of cases in the fewest countries ever.  But the last push is proving to be the most difficult and victory has eluded us for many years. However, as a recent Lancet editorial pointed out, we now have a good reason for believing that we can stamp out polio: We have a solid plan.

According to the editorial, the Global Polio Eradication Initiative’s (GPEI) six-year Strategic Plan to end polio “encouragingly contains intricate analyses of recent outbreaks in the three remaining countries, reasons for programmatic declines, and reflection on the lessons learned from success in India, which has not recorded a case in more than 2 years.” And “It is an excellent example of how data, local knowledge, and experience can be synthesised to provide clear goals and realistic targets.”

As the editorial notes, there have been plans with target dates and milestones in the past, which unfortunately have been missed. However, there are four elements that set this plan apart from previous ones:

The first is its sharp focus on the countries where polio hasn’t been stopped: Pakistan, Afghanistan, and Nigeria. Under this plan, world class polio experts are being deployed to each of the districts and even sub-districts where polio lurks. Innovative tools like mobile and GPS technology, and grassroots communication are now being used to locate hard-to-reach children and to solve other tough problems. Finally, the governments of Pakistan, Afghanistan, and Nigeria have played a huge role in designing and informing this plan – they are leading the charge.

All of the steps to the end of polio are laid out, from scaling up of the use of the inactivated polio vaccine (IPV) – the vaccine currently used in the developed world, to containing and destroying all polioviruses remaining in laboratories and production sites, to certifying that polio is in fact gone. There are many steps in this process. The plan methodically lays them all out.

The plan emphasizes the strengthening of comprehensive routine immunization systems that include polio as well as a range of other vaccine-preventable diseases, including measles and tetanus. Currently, 20 percent of the world’s children do not receive immunizations of any kind. Bolstering the basic health infrastructure will not only help us immunize this cadre of children against polio, it will also help us to reach them with other life-saving vaccines, clean water, and education.

Leaving a legacy. My mentors Bill Foege and Walt Orenstein are world-renowned epidemiologists who were part of the historic smallpox eradication campaign.  In addition to getting rid of the disease, both Bill and Walt were very proud of the legacy the effort left – a generation of global health leaders, hope for progress and change in even the poorest countries, and setting the stage for building routine immunization systems.  At the same time, they felt that even more could have been done to take advantage of smallpox eradication.

The new GPEI plan proactively seeks to shape a legacy for polio eradication.  From the incredible polio staff in the field to the use of cutting edge technology, GPEI will be working to harness the knowledge, resources, and visibility built up by the polio network to tackle other global health problems and improve immunization systems so all children receive their full complement vaccines.

The headline of the Lancet piece states “2018 must be the final target for polio eradication.” Unlike previous plans, the GPEI’s new plan is shaped with substantial input from a broad group of stakeholders, is grounded in local realities, and has built-in contingency plans. It lays out each step on the road to eradication – that’s why, at the foundation, we’re optimistic that the world can meet this deadline. Not only will this protect children for generations to come from this debilitating disease, it is also a critical step in reaching all children, no matter where they live, with the vaccines they need.

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