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~ l ~ ~~~,r,;a· ~ RLD W -~ THE MAGAZINE OF THE WORLD HEALTH ORGANIZATION HEALTH In this issue Caver. WHO/ EPI World Health Day 1995 Target 2000- A world without polio 3 Hiroshi Nakajima WHO'S new vaccines programme 4 Jong-Wook Lee Target 2000 6 Nicholas Word & Harry Hull Atemplate for the world 8 Ciro A. de Quadros Tracking the virus 10 Barbara Hull Rotary's Polio Plus 12 Cary Silver The quest for a vaccine 14 Fred Robbins Towards a world without polio 16-17 Supplying the vaccine 18 David Halliday & Julie Milstien Rehabilitating children with polio 20 Ann Goerdt Paying the price for one's beliefs 22 Paul Oostvogel Courage in adversity 24 JuneGoodfiel d No pain, no gain 26 Juan M. Flavier Egypt tackles polio 27 Esmat Mansour The role of women 28 Khadija A. Msambichaka Reaching the hard-to-reach 29 Stanislava Popova Costs and savings 30 David M. Salisbury page 2 1 World Health • 48th Year, No . 1, World Heolth is the officio! illusttoted mogozine of the World Health Articles ond photographs thot ore not copyright moy be reproduced provided January-February 1995 Orgonizonon . It oppeors six nmes oyeor in English, french, Russian ond credit is given to the World Health Organization . Signed articles do not Spanish, ond four times o yeor in Arabic ond fo ~i. The Ara bic edinon is necessar ily reflect WHO 's views. The designonons employedo nd the IX ISSN 0043-8502 ovoiloble fromWHO 's Regional Office fo r the Eastern Mediterranean, P.O. Box presentation of moteriol published in World Health do not im plyth e expression Correspondence should be addressed to the Editor, World Health Mogozine, 1517, Alexondrio 21511 , Egypt. The forsi edinon is obtoinoble from the of ony opinion whatsoever on the port of the Orgonizonon concerning the World Health Orgonizonon, CH· 1211 Geneva 27 , Switzerland, or direcriy to Public Health Cornrninee, Iro n University Press, 85 Pork Avenue, Teheran legol stotus of any country, territory, city or oreo or of its outhorines, or authors, whose addresses ore given ot the end of eoch article . 15875-47 48, Iron. The Russian edi non con be obtained from "Meditsino" concerning the delimitonon of its fronne rs or boundaries. for subscriptions see order form on poge 31 . Publishing Ho use, Petroveri gski per. , 6/ 8, 10 1000 Moscow, Russian federonon. World Health • 48th Year, No . l, Jonuory-february 1995 3 Editorial World Health Day 1995 Target 2000 - A world without polio Hiroshi Nakajima he world now stands on the Japan and the United States, are brink of global eradication of cooperating to ensure that critical Tpoliomyelitis. needs for advocacy, support and Since Jonas Salk in 1955, vaccine are being met. followed by Albert Sabin in 1961, Before we can sit back and enjoy produced and demonstrated the the benefits of polio eradication, effectiveness of their vaccines however, the job has to be against polio, and especially since completed. There is a need for WHO and UNICEF's Expanded national immunization days to be Programme on Immunization organized, for sustainable supplies brought potent, well-stored, safely of good quality vaccine to be administered polio vaccines to over stocked and delivered, for personnel 80% of the world's children, polio to be trained, and for epidemiological has been in retreat. In 1988, the Dr Hiroshi Nako;;ma, Director-General of the World Health survei llance to be established. World Health Assembly targeted Organization. But the task is not confined global polio eradication for the year exclusively to public health services. 2000, a fitting gift from health Only by joining forces with workers of this century to the governmental and nongovernmental children of the next. The key to success is the organizations, United Nations On 29 September 1994, an application of certain simple and agencies, and the public at large can International Commission headed by highly effective strategies. National the target be met on time. Everyone Dr Frederick Robbins was able to immunization days, during which involved in the polio eradication declare that the disease had been vaccine is given within a day or two initiative should be proud of the eradicated throughout the Region of to all children under five, supplement fact that his or her local efforts are the Americas, just ten years after the routine immunizations. Systems of making possible the realization of Directing Council of the Pan surveillance, which include testing the global goal. TARGET 2000 can American Health Organization faecal samples for the poliovirus, only be achieved by ensuring that committed its Member States to the identify and investigate all cases of village after village, district after eradication target. All regions of the flaccid paralysis in children. As district, country after country is world are now making steady fewer and fewer cases occur, wide polio-free. progress towards that goal. spread house to house immunization The eradication of polio is within The whole area of the Western finally reduces transmission to zero, our grasp. We owe it to future Pacific is about to become the second thus leading to eradication. generations not to let it slip away. • polio-free region in the world. On Many partners are working World Health Day- 7 April 1995 - towards this common goal. While it is anticipated that at least 15 almost 80% of resources needed for countries in Europe and the Eastern success will come from the endemic Mediterranean will provide polio countries themselves, many agencies vaccine to their children and institutions besides WHO, simultaneously. notably Rotary International, UNICEF, the US Centers for Disease Control and Prevention, and the Hiroshi Noka;ima, M.D. , Ph.D. International Development Banks, as well as the governments of Canada, 4 World Health • 48th Year, No. 1, Janua ry-February 1995 WHO's new vaccines programme Jong-Wook Lee Pitfalls ahead This is a remarkable achievement. What then are the problems that demand a new approach to immunization? Firstly, instead of ris ing to 90% as planned, immuniza tion coverage is now falling. In addition, there are at least 18 coun tries where immunization coverage remains less than 50%. If we are to protect every child, we must redou ble our efforts to increase coverage in countries which have extremely low coverage and stop the trend towards lower coverage in some Centre for total care in Egypt. An integrated approach to immunization offers children a better successful countries. chance to grow up in good health. Secondly, EPI has essentiall y been limited to the six antigens initially recommended by the pro have a right to be immunized- to a gramme. With some exceptions, we WHO's new Global broader one: all children must be have fai led to incorporate other, ex protected from death and di sability isting vaccines into the programme. Programme on Vaccines and by making the best vaccines Children in the developing world re available and using them in the most main at ri sk for hepatitis B, rubell a Immunization intends to use effective manner. To meet these ("German measles") and in some polio eradication as aleading needs, WHO has created a new countries yellow fever and infection Global Programme on Vaccines and with Ha emophilus injluenzae. Now wedge to implement Immunization (GPV). that so many countries are doing so effective, surveillance-based Twenty years ago, when the well , we must accelerate the intro Expanded Programme on duction of additional vaccines into approaches to neonatal Immunization (EPI) was founded, EPI programmes around the world. fewer than 5% of children born each Thirdly, poor quality vaccines tetanus elimination and year were immunized. In the last two have been used in some countries. measles control. decades, immunizat:on programmes All the effort involved in immuniz have been establi shed in every coun ing a child is wasted when there is no try of the world . WHO estimates that immunological response to the vac more than 75 % of infants born in cine. If un safe or impotent vaccines HO has embarked on a new 1993 were fu ll y immunized and 45% are used, parents lose faith and will phase in its task of protect of pregnant women were immunized no longer bring their children for im Wing the health of children to protect their infants again st neo munization. We must, therefore, around the world. An improved, natal tetanus. Wi th current levels of work with countries to ensure that integrated approach to immunization immunization, EPI prevents an only safe and effective vaccines are is needed if the world's ch il dren are estimated 2 900 000 deaths from used in EPI programmes. to grow up healthy. In turn, there is measles, neonatal teranus and Fourth ly, EPI's three disease a need to change the philosophy from whooping cough and 560 000 cases control objectives have yet to be a simplistic approach - all children of poliomyelitis each year. reached. WHO estimates that each World Health • 48th Yeor, No. 1, Jonumy-februory 1995 s year 110 000 children are still being crippled by polio, 500 000 babies die from neonatal tetanus, and I 200 000 children die from measles. Controlling these three diseases re quires an epidemiological approach to disease, defining high-risk groups and targeting immunization to those most in need. As is clear from this issue of World Health , the global po liomyelitis eradication target for the year 2000 is the most advanced of the three objectives. All the evidence indicates that this disease has been eradicated from the Western Hemi sphere, and rapid progress is being made towards the goal in the five A young child in Costa Rico receives protection against measles.