WHO Director-General Jong-wook Lee announced on July 29 that the agency will step up the global effort to eradicate polio. He has named David Heymann —who led the WHO effort to halt the severe acute respiratory syndrome (SARS) outbreak—as the Representative of the Director-General for Polio Eradication.
“I am immediately upgrading WHO's capacity to support India, Nigeria, Pakistan, and Egypt in their efforts to immunise every child against polio”, Lee said in his first media encounter as Director-General. 99% of the 235 new cases reported this year up to July 29 have come from these four countries.
Over the next 2 years, Heymann said, WHO will strengthen its approaches internally, increase engagement of endemic countries, broaden international partnerships to mobilise funds for polio, and devise a new strategy on what needs to be done after certification of polio eradication. “We believe that by the end of 2004 all countries, including India, Nigeria, and Pakistan will have interrupted transmission”, Heymann said. WHO has set 2005 as the deadline for global polio eradication.
“Just as with SARS, polio knows no boundaries”, commented Heymann. “In January, a child was paralysed by polio in Lebanon for the first time in 10 years. That virus travelled from India. Unless we stop transmission in the remaining polio-endemic countries, polio will spread to other countries, potentially reversing the gains already made.”
In the past 4 years, there were 12 cases of polio transmission into areas that had been polio-free—five of those originated in India.
Success of the polio eradication effort depends on mass immunization
© 2003 WHO
The success of the eradication drive now depends on mass immunisation campaigns in key endemic countries. Immunisation will take place from the end of August to December, and aims to reach a total of 175 million children. “For polio campaigns to reach every child, state and district-level governments must be committed and engaged”, Lee said. “Only then can poliovirus transmission be interrupted.”
Lee also put the onus on rich countries to support the eradication drive. “We face a funding gap of US$210million for activities through 2005”, he said. Following recent statements of commitment by G8 leaders in Kananaskis and Evian, Canada, Japan, Russia, and the UK have committed $95 million in extra funds. But Lee urged other G8 countries to contribute funds. “If we don't have sufficient funds, we will have to cancel these critical immunisation campaigns and cut back surveillance”, he warned.
“These are the leaders who control the levers of civil administrations that will be needed to overcome both the logistical and, in some way, cultural challenges—by reaching out to religious leaders, community leaders and fully utilising the communications mechanisms they have at their disposal.”
WHO officials say India will be at the top ofWHO's list for eradication. “We now need full engagement of the leadership at sub-national level—in Uttar Pradesh [India], Kano State [Nigeria], and Sindh Province in Pakistan”, said Bruce Aylward, coordinator for the WHO polio eradication initiative.
In March this year, Gro Harlem Brundtland launched an immunisation drive in Uttar Pradesh state, which had witnessed a resurgence of polio in 2002, causing global concern about a setback to the eradication drive.
“We have made progress in Uttar Pradesh”, said Deepak Kapur, Chairman, National Pulse Polio Committee of Rotary International in India. “There is ownership of the programme and greater accountability in administration. Constant monitoring from the top has helped a great deal.”
This year, 30 polio cases have been reported in Uttar Pradesh so far, compared with 1242 in 2002. “The number of new districts getting polio infection has gone down. National and sub-national immunisation days havebeen able to curtail transmission significantly and the strategy has worked—especially in highly endemic states like Uttar Pradesh and Bihar”, pointed out Dhananjoy Gupta, from WHO's National Surveillance Project.
The high number of polio cases in the first two months of 2003 represented the tail end of the outbreak in 2002, said Gupta. Polio transmission in India follows a seasonal trend. The low transmission period is February to April, and the high transmission season begins in May and peaks during August to October. SinceMay, only 11 cases of polio have been detected from five states. However, data from the high transmission period are not yet complete.
The Global Polio Eradication Initiative is spearheaded by WHO, UNICEF, Rotary International, and the Centers for Disease Control and Prevention. The poliovirus is now circulating in only seven countries, down from more than 125 when the initiative was launched in 1988.