The Global Polio Eradication Initiative announced that leading experts deem an unprecedented tactical shift essential in the campaign to free the world of polio. Immunization campaigns will be revised in 93 countries where polio transmission has already been stopped in order to commit more resources to the remaining seven polio-endemic countries, and six countries considered at high risk of reinfection.
The shift comes in response to the changing epidemiology of the disease, with polio more geographically contained than ever. Only seven countries remain endemic: India, Nigeria, Pakistan, Egypt, Afghanistan, Niger, and Somalia (listed from highest to lowest burden of disease). Virtually all the world's polio cases (99 per cent) are concentrated in just three countries: India, Nigeria and Pakistan.
Throughout the remainder of 2003 and during 2004, the eradication campaigns will focus only on the seven endemic countries, along with six other countries considered at high risk of polio reinfection – Angola, Bangladesh, the Democratic Republic of the Congo, Ethiopia, Nepal, and the Sudan.
In 2003, there will be 51 polio immunization campaigns in the 13 target countries. Additional campaigns will only be conducted as an emergency response to importations. By comparison, 93 countries held 266 campaigns in 2002. This shift in tactics will accelerate the accomplishment of global eradication by focusing on the endemic areas while protecting the substantial investments that have been made in these areas which are now polio-free.
The shift was announced by the core partners of the Global Polio Eradication Initiative, spearheaded by the World Health Organization (WHO), Rotary International, the US Centers for Disease Control and Prevention (CDC), and The United Nations Children's Fund (UNICEF).
The new tactic will shift 297 million additional doses of oral polio vaccine into the tightened geographic target zone, along with US$ 35 million in additional resources in 2003.
“Until we stop transmission of the poliovirus in the seven remaining infected countries, children everywhere will remain at risk of contracting this disease,” said Dr Gro Harlem Brundtland, Director-General of WHO. “Concentrating our resources on these strategic countries is crucial to root out and extinguish the remaining reservoirs of wild poliovirus.”
The tactical shift was finalized and adopted on 12 May 2003 by the Technical Consultative Group on the Global Eradication of Poliomyelitis (TCG), following its deliberations on 24-25 April in Geneva. This independent, technical body meets annually to provide strategic oversight to the Global Polio Eradication Initiative.
Even within the endemic countries, polio has been restricted to highly concentrated areas. In India, for example, the disease is contained primarily to areas of the north, but these pockets of disease have proven to be extremely dangerous. Following a cut-back in the number of polio immunization campaigns in India last year, the pockets of transmission in northern India caused the largest outbreak in recent history, a six-fold increase in new cases, and the re-establishment of transmission in previously polio-free parts of the country.
"The disease can be imported into countries that are polio-free by persons infected in polio-endemic countries," said Dr Walter Orenstein, Director, National Immunization Program, US Centers for Disease Control and Prevention, and chairman of the global TCG. Dr Orenstein noted that genetic sequencing confirmed that a recent case of polio in Lebanon had been imported from India. "That is why stopping transmission in the reservoir countries and intensifying surveillance in non-endemic countries is so critical. This focused approach is precisely the type of action needed to stop polio once and for all."
Protecting the investment that has been made by the international community and particularly polio-free areas will require even stronger surveillance, combined with a global emergency response capacity.
“Basically we're tightening the noose,” said Carol Bellamy, Executive Director of UNICEF. “Unfortunately, the funding needed to finish the job is extremely tight, too.” Ms Bellamy said that at the end of 2002, an additional US$ 275 million were needed to finish the job by 2005, with US$ 33 million urgently required for 2003 alone. “We need that money to make sure this new tactic is fully implemented, and we need it now,” Ms Bellamy emphasized.
To help narrow the funding gap through 2005, Rotary International launched a second major global fundraising drive among its membership, aiming to raise US$ 80 million by June 2003, for activities over the next three years. This is in addition to the US$ 500 million and countless volunteer hours Rotary members have committed to polio eradication since 1985. “The past successes of this initiative have been led by a unique sense of hope,” said Bill Sergeant, Rotary International. “The future successes will be led by the positive partnerships that have been forged since the initiative began.”
If successful, polio will be the first disease to be eradicated in the 21st century, and only the second after smallpox in 1979. Public health experts point to the dire circumstances if the eradication initiative falters now. Failure to eradicate polio would result in the resources invested being wasted, including over US$ 2 billion and the work of 20 million volunteers worldwide, international confidence in future global public health initiatives being compromised, and the number of annual polio cases drastically increasing.