Monday was World Polio Day, and there was much to celebrate: as of now, the world has seen a 99% reduction in polio cases. That’s incredible news. We have reached a point where polio could be wholly eradicated in less than five years. Isn’t it nice to hear that it is possible to successfully combat what was once a global health crisis? Unfortunately (yes, always), we’re not there yet. The Global Polio Eradication Initiative (GPEI), spearheaded by the WHO, CDC, Rotary International, and UNICEF (the Gates Foundation is their highest-profile partner), has vaccinated 2.5 billion children in 23 years. There have only been 467 recorded cases of polio so far in 2011. However, it proved to be a tough year for eradication efforts.
GPEI’s Independent Monitoring Board released a scathing report on Monday (PDF) that called for improvements to the GPEI program. As Judith Kaufmann pointed out in a blog post for Health Affairs, although the GPEI has a $535 million funding gap, the Monitoring Board focused on people management as a key obstacle to eradication efforts, as well as the need for data-informed improvements and more innovation. The report highlights the backsliding of some of the seven countries with persistent polio, such as Nigeria and Pakistan. Others, like India and Afghanistan, were praised for their efforts. In five of these countries, there have been more cases of polio in 2011 so far than at the same time in 2010, and unless drastic improvements are made, the GPEI will not be on track to eradicate polio by the end of 2012. Unfortunate “surprises,” such as an outbreak in China after ten polio-free years, are also worrying. The Monitoring Board questioned why “tired and ineffective” leaders remain in their positions at GPEI and pointed out that lack of compensation and adequate “rewards” were contributing to disinterest in front-line vaccination and surveillance work. Lack of accountability was also a key issue within GPEI and at local government levels in countries like Nigeria. Instability, conflict, and weak governmental structures in Chad, the DRC, Afghanistan, Pakistan, and so on, also contribute to the list of challenges. The call, as always, did come for more funding and more engagement by countries where polio is already history. There is some good news, however: India has had one case of polio in 2011 and may eradicate the disease by the end of the year.
In a piece for The Huffington Post, Bill Gates wrote, “The last one percent is the hardest percent.” Polio, for many, seems like an old-fashioned disease that no longer presents much danger, and without public interest and funding, the effort to eradicate it may founder. In places where polio has persisted, the risk of death, paralysis, and disability is omnipresent, and polio can spread quickly without efforts like the GPEI. The GPEI has made incredible progress, but without a strong push for that last one percent of cases, polio will endure. Achieving a 99% reduction in polio cases is one of humankind’s great achievements. We should celebrate this milestone and then dig in deeper, work harder, and pledge just a little more money to push our 99% success rate over to a hundred.
Header photo, of polio survivor and US President Franklin D. Roosevelt, by Margaret Suckley [Public domain], via Wikimedia Commons