Ending polio: the time is now

Editorial Board

Editorial Board

April 24th, 2013

Editorial Board

‘Experts from 80 countries say the window of opportunity for defeating polio will not stay open for long. A new push for eradication begins today.’

End-polio-nowHundreds of scientists, doctors and other experts from around the world have launched the Scientific Declaration on Polio Eradication, declaring that an end to the paralyzing disease is achievable and endorsing a comprehensive new strategy to secure a lasting polio-free world by 2018. The declaration’s launch coincided with the 58th anniversary of the announcement of Jonas Salk’s revolutionary vaccine.

More than 400 signatories to the declaration urged governments, international organisations and civil society to do their part to seize the “historic opportunity” to end polio and protect the world’s most vulnerable children and future generations from this debilitating but preventable disease.

Polio cases are at an all-time low and the disease remains endemic in just three countries but has eradication has proven more difficult than expected.

‘Time-limited opportunity’

Today at a Vaccine Summit taking place in Abu Dhabi (24-25 April 2013), the Global Polio Eradication Initiative is set to launch a new strategy to wipe out polio by 2018. This marks an acknowledgement that earlier deadlines set by the campaigners – most recently the goal of total eradication by 2015 – will not be met.
Experts now say that the final push will involve a switch to an inactivated vaccine. This requires an injection rather than just an oral drop. The oral dose costs about $0.20 whereas the inactivated vaccine costs around $1 more, according to an editorial in the Washington Post.
The oral live vaccine can, in rare cases, revert to a form capable of causing disease, including paralysis. As the incidence of wild polio diminishes, countries usually move from the oral vaccine to the injected vaccine.

Many industrialised countries have already switched from oral polio to the inactivated injectable vaccine. The oral vaccine was discontinued in the US in 2000 and in the UK in 2004.

The five-year strategy is estimated to cost $5.5 billion from varied sources, according to the eradication initiative, a partnership spearheaded by the WHO, Rotary International, the Centers for Disease Control and Prevention and UNICEF with support from the Bill & Melinda Gates Foundation.

“We have the tools we need and a time-limited opening to defeat polio. The GPEI plan is the comprehensive roadmap that, if followed, will get us there,” said Dr Walter Orenstein, professor and associate director of the Emory Vaccine Center at Emory University.

Dr Orenstein, one of the signatories to the declaration is a former director of the U.S. Centers for Disease Control and Prevention’s National Immunization Program, and was involved in the campaign to eradicate smallpox in the 1970s.

Routine immunisation

The attention and resources devoted to polio has attracted criticism from some commentators who are concerned that basic immunisation and primary healthcare are being overlooked. The new plan emphasises the need to strengthen routine immunisation in tandem with the polio eradication drive.

“Securing a lasting polio-free world goes hand in hand with strengthening routine immunisation. We need all countries to prioritise investments in routine immunisation,” said Dr Zulfiqar Bhutta, founding director of the Center of Excellence in Women and Child Health at Aga Khan University. Dr Bhutta, one of the declaration’s leaders, is a member
of the Strategic Advisory Group of Experts (SAGE) on Immunization, a technical advisory body to the GPEI.

As the last cases of polio are contained, high levels of routine immunization will be critical, according to the expert declaration. It says improving immunisation campaign quality eliminating rare polio cases originated by the oral polio vaccine are essential.

Securing progress

In light of recent attacks on health workers in some endemic countries, the declaration stresses the need to protect polio vaccination teams as they do their work. The GPEI plan includes a series of risk-mitigation strategies for insecure areas, including deepening engagement with community and religious leaders.

Only 223 new cases due to wild poliovirus were recorded in 2012, an historic low and a more than 99% decrease from the estimated 350,000 cases in 1988. India, long-regarded as the most difficult place to eliminate polio, has not recorded a case in more than two years.

“Eradicating polio is no longer a question of technical or scientific feasibility. Rather, getting the most effective vaccines to children at risk requires stronger political and societal commitment,” said Dr David Heymann, head and senior fellow at the Chatham House Centre on Global Health Security and a signatory of the declaration.

“Eliminating the last one percent of polio cases is an immense challenge, as is the eradication endgame after that. But by working together we can make history and leave the legacy of a polio-free world for future generations.”

Can polio be eradicated?