Bill & Melinda Gates Foundation

An Urgent Call to Finish the Job and End Polio

May 06, 2014

Yesterday marked another major milestone in the world’s effort to wipe out polio – a preventable but debilitating and highly infectious disease.  To date, major milestones in this effort reflected the progress in reduction of poliovirus transmission directly through facts and figures such as:

  • Since 1988, the number of new polio cases has dropped more than 99% from 350,000 a year to just over 400 in 2013; and from 125 countries to only 3 where polio transmission has never been stopped
  • In 2012, the world recorded the lowest number of new polio cases in history
  • In March of this year, India – once regarded as the hardest place to eliminate polio – was certified polio-free after marking three years without a single wild poliovirus case.
  • As a result of India’s success, WHO’s South east Asian region (including 11 countries and  representing 1.8 billion people) was certified polio-free.

However, for the first time in the history of the global polio eradication effort, the World Health Organization (WHO) declared polio a “public health emergency of international concern,and called for a coordinated international response including specific recommendations for  the 10 countries (including 7 that were re-infected) at highest risk of exporting the virus.  The recommendations call for vaccination of travelers intending to leave these countries with polio vaccine at least 4 weeks prior to travel

Some of the factors leading to this decision were:

  • 60% of the 68 cases in 2014 and 80% of cases in 2013 are due to spread from infected countries, with adults contributing to spread;
  • The season during which transmission of wild poliovirus is highest starts in June; and,
  • The recent spread of wild poliovirus has mostly gone to previously polio-free countries that are experiencing conflict and have very low routine immunization rates (e.g., Syria, Somalia); a number of  other countries are in similar  situations (e.g., Central African Republic, S Sudan, Ukraine) remain at  high risk of re-infection.

Another key factor contributing to this decision is that the world has never before been in a better position to end polio and coordinated action to reduce spread through travelers can speed achievement of this goal. 

This last statement may seem like a contradiction in the face of the declaration of an international emergency, but taking this additional measure to ensure immunization of travelers is  an important new tool for covering  the final mile to eradication.  In fact, other countries like Saudi Arabia for some time and India more recently, have already implemented polio vaccination requirements for people entering their countries from areas with active poliovirus transmission.  What the emergency creates is the opportunity to ensure countries work hand-in-hand and take the necessary steps to protect the incredible progress made to-date, reduce risk of spreading poliovirus through international travel and, ultimately, solidify chances for success. 

Finishing the job also means we are working with health ministries, regional stakeholders, and local and international NGOs  to quickly immunize children with polio vaccine, and – over the longer term – to raise routine immunization rates, in countries at high at-risk for reinfection. We also are continuing full steam ahead and remaining focused on ending polio transmission in the two areas of the world which are the reservoirs for all  polio cases today – Northern Nigeria and Pakistan.

This isn’t to say that the last mile is going to be easy.  It hasn’t been and it will continue to be tough.  At the same time we’re celebrating progress we haven’t seen before, we’re also dealing with challenges we haven’t seen before.  You can read more about this progress and the challenges  here.

The sounding of an emergency often is seen as a sign of distress, and news of this announcement certainly communicated that.  But what this alarm really signals is that working in close coordination we can do – and are doing – what it takes to end this disease as quickly as possible. 

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