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The Polio Conundrum

December 25, 2012

The horrific killing of vaccinators in Pakistan last week has raised fears that polio is going to get out of control like a raging fire. That is, until something dramatically different was done to deal with, or even work around, the worsening security situation. I sincerely hope these fears prove unfounded but a good attempt at taking stock of the disease control program is due anyways.

Polio (poliomyelitis) mainly affects children under five years of age. One in 200 infections leads to irreversible paralysis. Among those paralyzed, 5 per cent to 10 per cent die when their breathing muscles become immobilized. As long as even one child remains infected, children in all countries are at risk of contracting polio. Failure to eradicate polio from the last remaining strongholds could result in as many as 200,000 new cases every year, within 10 years, all over the world.

In 2012, only three countries in the world remain polio-endemic: Afghanistan, Nigeria and Pakistan. It was in 1994 that the WHO Region of the Americas was certified polio-free, followed by the WHO Western Pacific Region in 2000 and the WHO European Region in June 2002. Polio control campaign in Pakistan has been a mixed bag of success and failure over the years but now in all likelihood it is going to spread fast and reappear even in places where it was previously eliminated.

Afghanistan, which faces similar, or indeed worst, challenges to those in Pakistan, has made tremendous progress on eliminating polio. Since December 2010, vaccinators in Afghanistan have reached 25,000 more children who were previously inaccessible. The number of polio cases country-wide is down to a near record low, and contained within just two provinces - Helmand and Kandahar. So we know it can be done even in the most challenging environments.

Pakistan's President Asif Ali Zardari launched a National Emergency Action Plan for Polio Eradication, in January 2011, laying out a national blueprint to eliminate polio from the country. This included formal plans for tracking progress on polio objectively and regularly, setting up national and provincial task forces, and engaging Pakistan's leadership in polio eradication activities. Two days later, His Highness Sheikh Mohammed bin Zayed, Crown Prince of Abu Dhabi, and Bill Gates announced a partnership to help polio vaccines reach 32 million children in Pakistan. Then, British Prime Minister David Cameron announced that his country would double its contribution to polio eradication.

Such proclamations would not go a long way if we stick for too long to this security related narrative of failure of polio campaign. There is more to the polio conundrum than what is being proposed. It is indeed the program management’s failure to identify and focus on underserved population and mobile groups as well as operational and planning challenges to deliver vaccination door-to-door to more than 38 million children several times a year and achieving high coverage at UC level.

Smallpox is the only major human disease to have been eradicated. Epidemics of smallpox had inflicted mankind throughout history, and as recently as 1967, some 10-15 million cases were still occurring annually in more than 30 endemic countries. Of these some two million died and millions of survivors were left disfigured and/or blinded. There is no treatment for smallpox once it has been contracted. The more serious strain of the smallpox virus (variola major) causes fatality of 20-40 percent among unvaccinated persons.

In 1977, the last case of smallpox was reported in Somalia. For the first time, a major disease was completely vanquished. Dr H. Mahler, WHO director-general, described the smallpox program as "a triumph of management, not of medicine." It is said that at a meeting in Kenya in 1978 the then director-general, on announcing the end of smallpox, had turned to Donald Henderson who had directed the smallpox program, and asked him which was the next disease to be eradicated? Henderson reached for the microphone and said that the next disease that needs to be eradicated was bad management.

 


ayyaz_kiani_80
Ayyaz Kiani is a public health specialist. He heads Devnet – a network of development consultants. Based in Islamabad, he has travelled around the world and continues to do so to meet fellow travelers. He can be contacted at ayyaz_kiani@hotmail.com

 


The views expressed by this blogger and in the following reader comments do not necessarily reflect the views and policies of the Dawn Media Group.