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Home , Polio eradication

PROGRESS SHEET

The global fight against is one of the largest, most ambitious internationally coordinated health initiatives in history. It has mobilized millions of volunteers around the world, staged mass campaigns of unprecedented size, and helped strengthen the health systems of low-income countries. Today, is within reach, but we must remain vigilant.

The global response to polio represents one of the greatest 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 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 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 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 (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 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 levels against poliovirus type 1 nearly three times compared to the original OPV that can protect

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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 types 1 120 was the mobilization of millions of and 3—the two wild types currently volunteers around the world to fight COUNTRIES ENDEMIC POLIO OF NUMBER 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 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 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 , 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 , and parts of and among large and dense populations polio since 1988.9 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 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 (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 ) in 2000, and the 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

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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 ), 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 contained. 16 in these countries, more targeted also significantly contributed to the strategies are necessary to interrupt Sustained political and financial reduction of cases worldwide transmission. The GPEI has launched an commitment is required to ensure that by combining mass polio and measles accelerated research agenda to explore the final steps toward eradication can immunization campaigns. the best operational and technical be taken. Stopping the final chains eradication strategies for each of the of transmission in the endemic areas Moving Forward endemic areas. In 2009, an independent and ending the outbreaks of polio in Translating global and national political evaluation was launched to review the previously polio-free areas requires commitment to polio eradication into remaining barriers and to create tailor- resources. An estimated total of $2.3 local ownership and accountability is made, area-specific action plans. billion (U.S.) is required in external resources between 2009 and 2013, the single most important step toward Swiftly stopping outbreaks of polio in with a funding gap of $900 million ending polio. In the parts of the four previously polio-free areas is critical. (U.S.) (as of August 2009). countries where wild poliovirus is Between 2003 and 2007, 27 formerly 18 endemic and is still paralyzing children, polio-free countries were temporarily national and local government reinfected with imported poliovirus, authorities need to take additional 20 of them as a result of the virus steps and intensify efforts to protect originating from northern Nigeria. their children from infection. Ensuring West Africa is experiencing a new that social mobilization strategies polio outbreak from Nigeria that has create a greater local demand for reinfected eight West African countries

COUNTRY SPOTLIGHT: STOPPING POLIO OUTBREAKS IN SOMALIA22 Conditions in countries in the large parts of the country. The last 10,000 Somali health workers where reaching children midst of civil war or insurgency polio case was reported in March and volunteers—including repeatedly with a vaccine pose the greatest challenges 2007 in south-central . community, religious, and is uncertain, using this for polio eradication. Somalia is traditional leaders— targeted vaccine proved A combination of pioneering a country where transmission systematically visited extremely effective. approaches was critical to stop- of the poliovirus was stopped, every household in ping the 2005 polio outbreak Somalia demonstrates despite widespread conflict, large every village multiple in Somalia: that polio can be population movements, a de- times to hand-deliver SOMALIA eradicated everywhere, stroyed public health infrastructure, • To ensure rapid detection of polio vaccines to every even in the most and a dearth of functioning new polio cases, WHO’s country child under age 5. This challenging settings. government, through the use of office, as part of the GPEI, campaign resulted in the Such success stories innovative approaches tailored created an informal disease vaccination of 1.8 million help refine the strategies for to conflict areas. Somalia’s last surveillance network, with 100 Somali children. eradication and the delivery of case caused by indigenous wild Somalis across the country • To make the most of each other health interventions in poliovirus was reported in 2002. providing regular reports of any contact and immunize children conflict-driven countries as However, in July 2005 Somalia suspected cases. within a short period of well as for underserved and was re-infected by poliovirus • After new polio cases were time, the GPEI used the new vulnerable communities in originating in Nigeria, resulting identified in 2005, surveillance monovalent oral polio vaccine non-conflict conditions. in 228 paralyzed children. was complemented by to rapidly boost immunity Wide-scale response activities large-scale vaccination among children. In war-torn successfully stopped the outbreak campaigns throughout the countries such as Somalia, in spite of the ongoing civil war in country. Organized by GPEI,

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Endnotes

1. B. R. Aylward, A. Acharya, S. England, M. Agocs, 10. Global Polio Eradication Initiative, Strategic 19. This means that polioviruses are usually J. Linkins, “Global Health Goals: Lessons from Plan 2004–2008; WHO vaccine-preventable transmitted through contaminated water and the Worldwide Effort to Eradicate Poliomyelitis,” diseases monitoring system: http://www.who. food, or poor cleaning after handling feces. Lancet 372 (13 September 2003): 909-914. int/vaccines/globalsummary/immunization/ After infection, the virus is shed in feces for countryprofileselect.cfm (accessed 16 July several weeks. During that time, polioviruses 2. P. Fine, U. Griffiths, “Global Poliomyelitis 2009). can circulate silently and rapidly, depending on Eradication: Status and Implications,” Lancet 369 the level of sanitation, through (21 April 2007): 1321–1322. 11. B. R. Aylward, “Eradicating Polio: Today’s the community. Challenge and Tomorrow’s Legacy,” Annals of 3. Global Polio Eradication Initiative, Programme of Tropical Medicine 100, no. 5 (2006): 401–413; 20. Apart from wild polioviruses, there are vaccine- Work 2009 and Financial Resource Requirements Global Polio Eradication Initiative, Annual Report derived polio-, which evolve from the 2009–2013. 2008, http://www.polioeradication.org/content/ oral polio vaccine that, as a live vaccine, carries publications/AnnualReport2008_ENG.pdf. a small risk of vaccine-derived outbreaks. 4. Mop-ups are vaccination campaigns that back up routine immunization and NIDs and focus on 12. http://www.polioeradication.org/history.asp 21. http://www.polioeradication.org/disease.asp high-risk areas or where surveillance detects a (accessed 16 July 2009). (accessed 16 July 2009). rogue virus. 13. http://www.polioeradication.org/casecount.asp. 22. See Global Polio Eradication Initiative, 5. B. R. Aylward, K. A. Hennessey, N. Zagaria, J. M. “10,000 Health Workers Stop Polio in One of Olivé, S. Cochi, “When Is a Disease Eradicable? 14. World Health Organization, Weekly Most Dangerous Places on Earth: Somalia 100 Years of Lessons Learned,” Am J Public epidemiological record, 3 April 2009. Passes Polio-free Landmark,” press release, Health 90 (2000): 1515–20; D. L. Heymann, B. R. http://www.polioeradication.org/content/ Aylward, “Global Health: Eradicating Polio,” N 15. http://www.polioeradication.org/poliodonors. pressreleases/20080319press.asp. Engl J Med 351 (2004): 1275–1277. asp (accessed 16 July 2009).

6. The current OPV price for developing countries 16. B.R. Aylward, “Effective Vaccine Uptake. Lessons is 8 cents (U.S.) per dose, which is five times learned from the Global Polio Eradication lower than that of IPV. Initiative,” Presentation for Second Annual Beth Waters Memorial Lecture, organized by 7. D. L. Heyman, B. R. Aylward, “Poliomyelitis the Global Health Council; C. Kraayenoord, Eradication and Influenza,”Lancet “The ‘Extra Benefits’ of Polio Eradication,” 372 (13 September 2003): 909–914; C. Goudner, International Journal of Disability, Development “The Progress of the Polio Eradication Initiative: and Education 52, no. 3 (2005): 169–174. What Prospects for Eradicating Measles?” Health Policy and Planning 13, no. 3 (1998): 212–233. 17. Global Polio Eradication Initiative, Monthly Situation Report, July 2009. 8. Global Polio Eradication Initiative, Annual Report 2008; B. R. Aylward, “Polio Eradication: 18. Global Polio Eradication Initiative, Programme of Setting the ‘Context’,” presentation to the GPEI Work 2009 and Financial Resource Requirements Independent Evaluation Team, June 2009. 2009–2013, 2008.

9. http://www.polioeradication.org/history.asp (accessed 16 July 2009).

The Living Proof Project is a multimedia initiative intended to highlight successes of U.S.-funded global health initiatives. Millions of lives have already been transformed and saved with effective, affordable solutions. We have the knowledge, innovative technologies and proven tools to do much more. The content for this progress sheet was developed by the Global Health Group at the University of California, San Francisco and SEEK Development in Berlin. It is also available online at www.livingproofproject.org.

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