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Progress Against Polio

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Progress Against Polio PROGRESS SHEET 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 achievements in global health in recent decades. Estimates spearheading partner in polio eradication efforts, having suggest that 350,000 children were paralyzed by the poliovirus played key roles through advocacy, donating funds, and in 1988.1 Since then, the Global Polio Eradication Initiative mobilizing volunteers. Rotary launched its PolioPlus program (GPEI) has shown that a strong global commitment combined in 1985 and has been driving the vision of a polio-free world with an unprecedented, internationally coordinated effort has since. More than 1 million Rotary members have volunteered the potential to create greater health equity and attainment in the field during NIDs. Rotary has also played an important of an enormous public health success: the eradication of a advocacy role by leveraging its political access and its devastating disease. Since 1988, about 2.5 billion children have grass-roots networks to directly engage policymakers. been vaccinated against polio worldwide. In the same period, By 2008, Rotarians had contributed $800 million (U.S.) to the global number of polio cases has been reduced by more polio eradication. than 99 percent. The fight against polio has reaped important dividends for global health in general. Implementing polio eradication Global Progress strategies, including routine immunization, surveillance, The fight against polio constitutes one of the largest globally NIDs, and “mop-ups,”4 has contributed to building up coordinated health initiatives in history.2 It was launched by countries’ health systems and galvanizing high-level political the World Health Assembly in 1988 to free the world from support by scaling up advocacy and resource mobilization. polio, and is spearheaded by national governments, the The initiative has also invigorated research and product World Health Organization (WHO), Rotary International, development activities.5 the U.S. Centers for Disease Control and Prevention (CDC), and the United Nations Children’s Fund (UNICEF). The Innovation and Scientific Advances effort to eradicate polio has mobilized more than 20 million The development of vaccines that effectively protect against volunteers in 200 countries, who have helped conduct mass polio was a major medical breakthrough of the 20th century: immunization campaigns, known as National Immunization Days (NIDs), of unprecedented size. • The firstinactivated polio vaccine (IPV) was licensed in 1955, followed by a live orally administered vaccine against Thanks to extraordinary commitments from the global polio (OPV) in 1961. Administered multiple times, the OPV community, funding for polio eradication increased protects a child for life and can interrupt the transmission dramatically from $10 million (U.S.) in 1988 to $785 million of the poliovirus. As it can be provided by volunteers, even (U.S.) in 2008, as the program moved into the more difficult in low-resource settings, and is inexpensive, it is the vaccine areas of the world and set up its on-the-ground infrastructure. of choice for most national immunization programs, and An important milestone occurred in 1996, when funding whenever a polio outbreak needs to be contained. increased to $200 million (U.S.) from less than $50 million (U.S.) 6 just one year before, a big part of which came from the United • Taking advantage of the eradication of type 2 poliovirus, States government. The G8 countries account for half the a new monovalent OPV was introduced in 2005, which financing for the Global Polio Eradication Initiative (GPEI).3 increases immunity levels against poliovirus type 1 nearly three times compared to the original OPV that can protect SEPTEMBER 2009 1 PROGRESS AGAINST POLIO against all three types of poliovirus. enabled countries to respond more This can be especially useful in effectively to polio and other disease POLIO rural and conflict-affected areas, outbreaks, such as cholera, avian flu, ERADICATION where reaching a child repeatedly is and yellow fever.7 PROGRESS difficult. bivalentA OPV that protects • A groundbreaking achievement against wild polioviruses types 1 120 was the mobilization of millions of and 3—the two wild types currently volunteers around the world to fight NUMBER OF POLIO ENDEMIC COUNTRIES in circulation—will be available from a single disease. 100 November 2009. • New ground was also broken in • Heat-sensitive markers on vaccine 80 establishing on-the-ground technical vials help vaccinators in remote support systems. Technical support— locations monitor the quality spanning expertise from epidemiology 60 of the vaccine. The development to surveillance to management and of these vaccine vial monitors has advocacy—is provided by more 40 enabled polio vaccination to move than 3,300 on-the-ground polio beyond the formal cold chain while staff worldwide. maintaining vaccine effectiveness. 8 20 • A global laboratory network The global polio initiative has also consisting of 145 laboratories allows introduced critical management and 0 confirmation of suspected polio operational innovations, which have 1985 1992 1999 2006 cases and supports the global polio Figure adapted from: Aylward, Bruce R. Polio surveillance system that provides eradication: Setting the ‘context’. Presentation to the weekly case data from every country Global Polio Eradication's Independent Evaluation Team, June 2009. WHAT IS POLIO? on Earth. Poliomyelitis (polio) is a highly Results infectious disease that is caused by • Few endemic areas left: By 2008, a virus and mainly affects young Global progress toward polio the number of endemic countries had children. Eliminated in industrialized eradication has been remarkable. been reduced to four—from 125 in countries, polio has remained a 1988. Northern Nigeria, northern challenge for developing countries, • About 2.5 billion children around the 12 particular for the poor, as it spreads globe have been vaccinated against India, and parts of Afghanistan and among large and dense populations polio since 1988.9 Pakistan are now the only remaining suffering from poor sanitation and areas where endemic transmission of hygiene standards. The poliovirus • Global coverage of children with the the poliovirus has not been stopped. is spread from person to person, oral polio vaccine increased from 67 These regions account for more than percent in 1988 to 82 percent in 2007. primarily through the fecal-oral route 10 75 percent of global polio cases today.13 of transmission. Most people infected 19 The dramatically increased coverage with polio (90 percent) show no signs • Polio-free regions: In 1994, the with polio vaccination is having an of illness, are never aware of the Americas (36 countries) were certified infection, and continue to transmit effect. Today, polio eradication is within polio-free, followed by the WHO the virus to others. reach, and if attained, polio would Western Pacific Region (37 countries become the second disease after There are three types of wild including China) in 2000, and the smallpox to have been successfully (naturally occurring) poliovirus.20 WHO European Region (51 countries) eradicated from the globe. Circulation of wild poliovirus type in 2002.14 2 was interrupted globally in 1999. • Dramatically reduced polio incidence: • Lives saved: 250,000 polio deaths The poliovirus can be highly virulent, In the 20 years following the creation and one in 200 infections leads to have been prevented in the 20 of the GPEI, the number of global irreversible paralysis, mostly in the years since the GPEI was launched polio cases was reduced by more legs. Among those paralyzed, 5 to in 1988. In addition, more than 5 10 percent die when their breathing than 99 percent. According to WHO million people who would have been muscles become immobilized. estimates, the number of new polio paralyzed and incapacitated by polio cases has declined from 350,000 Young children are at high risk. More without global support have been annually in 1988 to only 1,652 than 50 percent of all polio cases occur protected and are symptom-free.15 in 2008. in children under the age of 3. There 11 21 • Delivery of other critical health is no cure for polio, but polio vaccines • Circulation of wild poliovirus type 2 services: Beyond polio, millions that effectively protect against stopped: The last polio case caused of lives have been saved through polio were developed in the 1950s by wild poliovirus type 2 was and 1960s. the delivery of other critical health detected in 1999. services in the context of polio SEPTEMBER 2009 2 PROGRESS AGAINST POLIO immunization campaigns. Millions polio immunization and assuring that since 2008.17 Aggressive multi-country of insecticide-treated bed nets (to local governments live up to their outbreak responses are currently prevent malaria), vaccines, and responsibilities remains a key priority. ongoing in the region. To safeguard the vitamin A doses have been delivered gains of eradication, such outbreaks While there has been notable progress to people in need. The initiative has must be swiftly
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