In 1988, the World Health Assembly, a body comprised of Ministers of Health from every WHO member nation, established the goal of global eradication of poliomyelitis. At the time, wild poliovirus was endemic in more than 125 countries on five continents, paralyzing more than 1000 children every day. Only 677 cases of polio have been reported in 2003 (as of 13 January 2004), representing a greater than 99 percent reduction in poliovirus. Today, only six countries in the world remain polio-endemic (Nigeria, India, Pakistan, Egypt, Niger and Afghanistan).
The Global Polio Eradication Initiative (GPEI), spearheaded by national governments, the World Health Organization (WHO), Rotary International, the US Centers for Disease Control and Prevention (CDC) and UNICEF, is the largest public health initiative the world has ever known. Since 1988, some two billion children around the world have been immunized against polio thanks to the unprecedented cooperation of more than 200 countries and 20 million volunteers, backed by an international investment of US$ 3 billion.
In 2004, the world has a one-time opportunity to make good on this global investment by ending transmission of poliovirus, now and forever.
1988-2002 eradication milestones
1991 – Last case of polio in the Americas (Peru) 1997 – Last case of polio in Western Pacific (Cambodia) 1998 – Last case of polio in Europe (Turkey)
The Americas, Europe, and Western Pacific regions of the World Health Organization were certified polio-free in 1994, 2002 and 2002 respectively. More than three billion people now live in 134 countries and territories certified polio-free.
2003 – Recent Status
Poliovirus is more geographically restricted than ever before in history. Only six countries remain polio-endemic. More than 75% of all polio cases worldwide linked to just five key polio hotspots within these countries: Kano (Nigeria), Uttar Pradesh and Bihar (India) and Sindh and North West Frontier Province (Pakistan).
Importations of poliovirus from endemic to polio-free areas threaten to derail efforts to contain the virus. In the 2002-2003 period, for the first time in history, more countries suffered polio cases due to importations than were themselves endemic for the disease.
2004 – Final Push for Polio Eradication
Stopping transmission of poliovirus by end-2004 is the overriding objective for all six remaining polio-endemic countries. In 2004 the world has its best – and perhaps last - chance to stop polio forever. Epidemiologically and programatically, a one-time opportunity now exists to stop transmission of poliovirus, but political will must be galvanized across all levels – international, national, state/provincial and local -- in order to immunize every child and capitalize on this opportunity.
To stop poliovirus transmission by the end of 2004, endemic countries must immediately take decisive action to vaccinate every child under five years old multiple times especially within the next six months during the low-transmission season, particularly in the five main polio hotspots of Kano (Nigeria), Uttar Pradesh and Bihar (India) and Sindh and North West Frontier Province (Pakistan).
Nigeria currently poses the highest risk to the end-2004 target for global polio eradication. In 2003, Nigeria had the highest number of polio cases anywhere in the world (302 as of 13 January 2004), and accounted for 45% of all confirmed cases globally. A number of states in Nigeria, especially Kano, stopped participating in sub-national immunization campaigns in autumn 2003 due to unfounded rumours of lack of vaccine safety, leading to a dramatic decline in overall immunity levels and a significant increase in polio cases.
The Nigerian state of Kano now has more polio cases than any other area in the world, including Uttar Pradesh in India, until recently the world’s largest polio reservoir. Kano has a significantly smaller population (1/ 20th the size) than Uttar Pradesh.
Poliovirus from the north of the country is re-infecting previously polio-free areas within Nigeria, including the densely populated city of Lagos, and nearby countries. This year, poliovirus from Nigeria has been exported to Benin, Burkina Faso, Cameroon, Chad, Ghana, Niger and Togo, threatening children across west and central Africa.
Many states in the south of Nigeria were polio-free from mid-2001 to mid-2003, demonstrating that transmission can be stopped in the north if high-quality immunization campaigns are conducted throughout 2004.
Urgent actions for 2004
Restart national immunization campaigns - with the participation of every state, local government authority and community. Dramatic improvement of the quality of these immunization campaigns, particularly in the north, to reach each child.
Active support of leaders – particularly state, local and traditional leaders to take oversight of immunization campaigns, especially in the northern states.
Full accountability among state and local leaders - for mobilizing communities and disseminating correct information on vaccine safety.
Within India, the greatest risk is western Uttar Pradesh, the only area of India which has never stopped wild poliovirus transmission.
India presents the greatest opportunity for success or failure in stopping polio transmission early in 2004. Last year, India dramatically increased the quantity and quality of its large-scale immunization campaigns. As a result, India now has the lowest-ever levels of poliovirus transmission in the key polio hotspots of Uttar Pradesh and Bihar as the country enters the critical low transmission season, for poliovirus in early 2004.
Recent efforts have increased OPV coverage among Muslim communities in Uttar Pradesh from 58 percent in 2002 to 87 percent in 2003.
Urgent actions for 2004
Closing of immunity gap in Uttar Pradesh, Bihar and West Bengal - by reaching all children, particularly minority populations, during immunization campaigns in 2004 (particularly from January to June). Organization of multiple vaccination campaigns to protect the rest of the country while stopping transmission in these polio hotspots.
Full accountability at the state and district level - to implement quality immunization campaigns.
Full involvement of the local population - particularly Muslim, underserved and minority communities.
Pakistan President Musharraf has requested monthly briefings on the country’s progress in polio eradication.
Pakistan had the third highest number of cases globally of polio (99 cases as of 13 January 2004), with endemic poliovirus concentrated in two key provinces and areas, North West Frontier Province and Sindh. Transmission and immunity gaps also exist in Baluchistan and central Punjab.
Transmission was reduced during the high transmission season in Sindh, a key polio reservoir. Polio cases in Pakistan declined in the second half of 2003 despite the high transmission season.
In 2003, a prolonged polio-outbreak in the densely populated area of east/central Punjab demonstrated the fragility of the progress that has been made, the need to maintain very high coverage throughout the country and the need for rapidly responding to importations with high quality activities.
Urgent actions for 2004
High-quality immunization activities - by increased access to all children in all provinces, especially in traditional and tribal areas, through the use of female vaccinators, improved communications and better community mobilization.
Greater governmental accountability – through presidential oversight, at provincial and district levels for immunization activities.
Polio cases in Niger have increased in 2003 as a result of both indigenous transmission and importations from northern Nigeria.
Nomadic populations present a particular challenge in ensuring adequate immunization coverage.
Virus from northern Nigeria was transmitted through Niger to reinfect Benin, Burkina Faso, Ghana and Togo.
Urgent actions for 2004
Dramatic improvement in quality of immunization activities - especially in highly populated southern and western areas, and with nomadic populations. Synchronize activities with Nigeria.
Strong communication efforts - to ensure full participation by all communities in immunization campaigns.
Greater governmental accountability - at the provincial level for immunization efforts.
A single case of polio was reported in Upper Egypt in 2003, due to a virus from greater Cairo. The greater Cairo area (Cairo, Giza and Kalyoubia) presents the last remaining challenge for eradicating polio from Egypt.
The number of positive environmental samples collected in 2003 decreased markedly, falling from 55 percent in 2001 to four percent in 2003, primarily in the greater Cairo area.
Population immunity increased markedly in 2003, under the new Minister of Health, as the quality of immunization campaigns improved, with a particular focus on Cairo, Alexandria and other large cities.
Urgent actions for 2004
Reach all children house-to-house - in the densely populated districts and high rises of the greater Cairo area through intensification of planning, supervision, training and communication efforts.
Full governmental ownership - at governorate and district levels, particularly in greater Cairo, for immunization activities.
Two areas of indigenous transmission existed in 2003: the southern region (including Kandahar) and the western region (Herat).
Repeated importations, especially along the Pakistan border, continue to pose challenges.
Immunization status has improved over time, but areas of major concern remain in the southern and western regions, as well as those areas bordering Pakistan. Security concerns in the south are a key challenge to ensuring adequate immunization coverage.
Urgent Actions for 2004
Access to all children - particularly in the southern region, through greater engagement with local staff and improved communication and community mobilization efforts.
Government accountability - to maintain commitment to polio eradication.
Synchronized immunization activities - with Pakistan.
In 2003, there were 23 cases of paralytic polio following importations of poliovirus into previously polio-free countries of Benin, Burkina Faso, Cameroon, Chad, Ghana and Togo.
Viruses found in these countries, which had not reported indigenous wild poliovirus for more than two years, are related to virus circulating in northern Nigeria and southern Niger in 2002 and 2003.
Benin, Burkina Faso, Cameroon, Chad, Ghana and Togo will conduct two to four rounds of National Immunization Days/Sub-National Immunization Days in 2004 to ensure transmission is not re-established.
International Efforts in 2004
The G8 reinforced its commitment to polio eradication during its June 2003 Summit, and pledged to provide the funding needed for polio eradication activities in Africa. To date Canada, the United Kingdom, Japan, the Russian Federation and the United States are the G8 countries which have acted on their commitment to provide additional funding for polio eradication activities.
Several key multilateral organizations made strong commitments to polio eradication in 2003. At the 2003 African Union Summit in Maputo, the African Union recalled its 1996 resolution to “Kick Polio Out of Africa” with a further decision on polio eradication. In October, the Organisation of the Islamic Conference (OIC) adopted a landmark resolution to wipe out polio. Five of the world’s six remaining polio-endemic countries globally are OIC members – Nigeria, Pakistan, Egypt, Afghanistan and Niger. The resolution urges the OIC polio-endemic countries to accelerate their eradication efforts.
Rotary International announced the results of its second membership fundraising campaign, which raised more than US$ 111.5 million. Funds received during this campaign pushed Rotary’s total donation to polio eradication to well over US$ 500 million.