World Health Day

7 April 1995

[1995 World Health Day: GLOBAL POLIO ERADICATION]

Perhaps the greatest example of cooperation among nations for the common good has been the global eradication of smallpox. During an 11-year period. all countries united under the leadership of the World Health Organization (WHO) to stop transmission of variola virus, using a vaccine discovered 170 earlier. Today the world stands on the brink of a similar achievement - the eradication of polio from the entire world which the World Health Assembly has targeted to achieve by the year 2000 - a fitting gift from health workers of this century to the children of the next.

The polio vaccines first produced by Jonas Salk in 1955 and then by Albert Sabin in 1961 make this initiative possible.

The theme of this year's World Health Day scheduled for 7 April 1995 is polio eradication. Many countries will be participating in World Health Day by conducting mass immunization campaigns against polio. For example, Operation MECACAR is a joint effort of the Eastern Mediterranean and European Regional Offices of WHO to eradicate poliomyelitis from the Middle East, the CAucasus and the Central Asia Republics. Countries in these regions will be conducting mass immunization campaigns during the period of March to May 1995 to immunize nearly 70 million children against polio.

This will be one of the largest events ever in public health, second only to the National Immunization Days in China when 83 million children were immunized in the course of two days.

[1988 incidence map]

[1993 incidence map]

[graph of annual incidence]

[PROGRESS TOWARDS THE GOAL]

Currently, all regions of the world are making steady progress towards the goal of polio eradication. In September 1994, an International Commission declared that the disease has already been eradicated throughout the countries of the Americas.

[THE THREAT OF IMPORTATIONS]

Despite the progress, no country can relax until polio is completely eradicated.

The poliovirus can be easily imported into polio-free countries by infected persons arriving in the country. One well-documented instance was in 1992 when poliovirus was imported into Canada from the Netherlands, where an outbreak occurred among a small religious group refusing immunization. In the Netherlands, there were 71 cases of polio - all but one from the religious community. The virus later spread to a related religious group in Canada but no cases of paralysis occurred.

[RECOMMENDED STRATEGIES]

Current eradication strategies recommended by the World Health Organization include national mass campaigns administering oral polio vaccine to all children under 5 years of age, enhanced surveillance to detect cases of acute flaccid paralysis, targeted immunization in populations where poliovirus transmission is likely to persist, and creation of a global network of laboratories for viral surveillance.

This laboratory network performs sophisticated viral detective work to pinpoint not only the type of poliovirus responsible for an outbreak, but also its precise geographical origin and relationship to other strains of the virus. To date there are more than 60 national laboratories working in close collaboration with epidemiologists who investigate patients with acute, flaccid paralysis.

Fecal specimens from these patients are brought to the laboratory for virus isolation and identification of poliovirus. These laboratories are supported by 15 regional reference laboratories which supply reagents, provide on-the-bench training, and perform more sophisticated techniques.

Five specialized laboratories provide global support for research, production of specific reagents and development of training materials.

Analysis of virus strains have revealed "homelands" for certain strains or "genotypes" of poliovirus. Maps have been constructed showing the global distribution of these major families. The programmatic implications of this molecular epidemiology are far-reaching. Eradication activities can be directed at eliminating genotypes from their homelands even when they extend across national and regional boundaries. These coordinated activities are being undertaken in several groups of countries.

[PRINCIPAL OBSTACLES]

1. Ensuring top-level political commitment in countries where polio persists.

2. Mobilizing urgently needed additional resources from industrialized polio- free countries in the form of key health professionals and resources for vaccine purchase.

3. Ensuring that the appropriate WHO recommended strategies are being followed. If few cases of polio are being detected in a country, it is difficult to accept that nationwide mass campaigns will still be needed, but they will.

4. Ensuring that the polio eradication initiative is not abandoned in countries at war or undergoing major political, economic or social upheavals. In some countries civil war has paralysed governments forced withdrawal of international agency workers and blocked the delivery of vaccines. In countries such as Afghanistan, El Salvador and Sudan, so called "Days of Tranquility" or "Corridors of Peace" have been organized to allow children on all sides of a conflict to be immunized.

[ANN0UNCING NIDS]

[THE COST]

Polio eradication will cost approximately US$ 160 million annually until the year 2000 to achieve the goal of polio eradication of which $100 million annually is still needed..

Is it cost effective? A global cost-benefit study carried out for WHO by the Centers for Disease Control (CDC) in Atlanta, USA, estimates that if polio is eradicated on target by the year 2000, the cumulative benefits will exceed the costs by approximately US$125 million by the year 2005.

Polio eradication is being achieved through a partnership which includes the countries themselves, Rotary International, WHO, UNICEF and bilateral donors including Japan, The USA, Canada and Australia. In addition, a number of other countries - notably Denmark, Sweden, the Netherlands and the United Kingdom - strongly support all immunization activities. Rotary International provides a unique example of the support which the private sector can provide to public health programmes. Rotarians have donated US$246 million to purchase oral polio vaccine and provided thousands of volunteers to support immunization campaigns.

Is funding a problem? Yes. There is an urgent need for increased donor funding.

[THESE OBSTACLES CAN BE OVERCOME!]

However, these obstacles can be overcome if the world unites to provide the additional financial resources, personnel and vaccine needed. We can then look forward to the day when parents need no longer fear that their child will be crippled by poliomyelitis. The eradication of polio is within our grasp. We owe it to the future generations not to let it slip away.