Renewed Efforts to End Polio in South Asia

Success of the effort to rid the world of polio now depends largely on...

10 October 2006 - South Asia, home to three of the world’s four remaining polio endemic countries, is addressing the lingering challenges of polio eradication through revamped strategies, including stepped-up immunization activities.

India, which has the highest incidence of indigenous polio in the region, is responding to an outbreak that has caused 373 cases of polio this year, 328 of them coming from just one state, Uttar Pradesh.

According to health officials, India’s outbreak stems from a failure to immunize all children in states affected by polio. Many parents, especially in poor Muslim communities, are reluctant to have their children immunized because of false rumors that the oral polio vaccine is contaminated.

To address these fears, health workers and volunteers are carrying out new community outreach efforts. They’re also organizing immunization campaigns involving a combination of fixed-post and door-to-door delivery of the polio vaccine.

Rotary clubs are supportive of the renewed efforts, says India National PolioPlus Committee Chair Deepak Kapur. “Rotarians are responding very well to the situation,” he notes.

In August, the committee invited almost 90 Muslim clerics, scholars, and leaders to a conference in Delhi, India’s federal capital, to discuss their community’s polio concerns. Rotary clubs are now distributing public service announcements and fliers that feature Muslim leaders encouraging families to take their children for polio immunization.

“The messages we have placed on local TV include appeals from parents of polio victims to the public to protect children through immunization,” says Kapur.

Rotary clubs are encouraging Muslim clerics to set up vaccination booths at mosques and to announce immunization events at Friday prayers. Rotarians also are helping recruit volunteers from local Muslim communities, especially in Moradabad, the epicenter of the polio outbreak.

In other parts of South Asia, the Global Polio Eradication Initiative is helping devise responses suited to each country’s challenges. For example, in Pakistan, the National PolioPlus Committee is disseminating polio-related messages to at-risk groups on the radio.

“Studies carried out in the past indicate that polio-related messages conveyed through local FM radios reach a much higher percentage of target populations in rural areas or working-class and low-income groups,” explains Abdul Haiy Khan, chair of the committee.

According to Khan, a coordinated, intergovernmental response would help address challenges common to Afghanistan and Pakistan. Both countries are polio endemic and have reported 26 and 20 cases of polio this year, respectively. Lawlessness, a leading cause of low immunization rates along the Afghanistan-Pakistan border, could be jointly tackled, Khan says.

In Bangladesh and Nepal, which were polio-free until they were reinfected with a strain of poliovirus from neighboring India, volunteers and health workers are determined to make the imported cases of polio a temporary setback to their efforts.

“We face many difficulties, but the support given by government and Rotary International have made us even more determined to stop imported polio from spreading in our country,” says Iftekharul Alam, chair of the Bangladesh National PolioPlus Committee.

Total cases in 2006 compared to same period in 2005

Globally 1441 in 2006 vs 1392 in 2005
- in endemic countries: 1337 in 2006 vs 586 in 2005
- in non-endemic countries: 104 in 2006 vs 806 in 2005

Eradication now hinges on more commitment from polio-endemic nations

The success of the effort to rid the world of polio now depends largely on "political will" in the four remaining polio-endemic countries according to the Advisory Committee on Polio Eradication (ACPE). The APCE, which provides independent oversight on the fight against polio, addressed the media on 12 October during its third annual review meeting at World Health Organization headquarters in Geneva.

Polio-endemic Afghanistan, India, Nigeria, and Pakistan have all reported new cases of polio this year. India is experiencing a challenging outbreak that has so far infected 386 children, most of them in the state of Uttar Pradesh. In response, health officials and politicians in the four countries are pledging renewed commitment to the goal of eradication.

"Polio eradication hinges on vaccine supply, community acceptance, funding, and political will," said Robert Scott, chair of Rotary's International PolioPlus Committee. "The first three are in place. The last will make the difference."

"With a more effective monovalent vaccine and accelerated lab processes for identifying poliovirus, these countries have the best tools we've ever had," noted Stephen Cochi, ACPE chair and senior adviser to the director of the global immunization division at the U.S. Centers for Disease Control and Prevention. "Eradicating polio is no longer a technical issue alone. Success is now more a question of the political will to ensure effective administration at all levels so that all children get the vaccine."

The most serious setback to the goal of completely eliminating the poliovirus occurred when some states in Nigeria boycotted the oral polio vaccine for 11 months. That boycott ended in 2004, but the polio outbreak it triggered eventually reinfected 25 countries in Africa, the Middle East, and Asia. After aggressive immunization campaigns, however, most of the affected countries have since stamped out the imported cases of polio.

ACPE officials noted that several governments are already showing the political resolve needed to finish the job of eradicating polio. For example, Afghan President Hamid Kharzai moved polio immunization directly under his office, after a spike in new polio cases in southern Afghanistan. And Saudi Arabia now requires proof of polio immunization for Muslims traveling to Mecca for this year's pilgrimage.

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