Goal is zero cases, he says; eradication failure to lead
to 200,000 polio cases per year worldwide
Islamabad
There is no room for a 99.9% decline in polio eradication: the goal is zero cases everywhere, and no more viruses anywhere. Because polio cannot be ‘controlled,’ it can only be eradicated. Fewer cases and less frequent occurrences do not provide any justification for the world to surrender the fight. Any lost terrain would irremediably reopen sage heavens for the virus to transmit freely again.
The 23 cases reported so far in 2016 would quickly trigger a dominos effect, with thousands of new cases falling down in just a few years only. Global polio eradication is unstoppable, and failure to eradicate would lead to 200,000 cases of polio per year, worldwide. Once achieved, polio eradication will leave an immense legacy of practices that will benefit public health initiatives for generations.
The Representative of the World Health Organisation (WHO) in Pakistan Dr. Michel Thieren has expressed these views in a written statement released to the media on Tuesday in connection with World Polio Day.
Dr. Thieren believes “it is inevitable that polio will be stopped by the end of 2016.” The belief is grounded in evidence of the virus being on the run, as attested by core polio epidemiological indicators; as well the unprecedented uniformity in genetic sequences of the collected viruses, which also indicate near-extinction of the virus.
“All trend lines are swiftly heading for zero, with no return possible to the dark ages of the crippling disease,” Dr. Thieren expresses. According to the WHO chief, “Wherever the virus is still actively transmitting (i.e., mostly in Afghanistan and Pakistan), the core polio epidemiological indicators attest that the virus is on the run. The number of new cases, and the presence of the virus in the environment is facing a historic decline, with low results in both countries. The last reservoirs of polio are almost cleared of polio cases, and cleansed from the endemic strain of indigenous poliovirus.”
World Polio Day 2016, which is very likely to be the last one celebrated in a polio endemic world, is less an opportunity to set a final date for viral elimination, than it is to reflect one last time on the three meanings of a polio-free world for the next generation of children, the WHO chief states before moving on to explain those three meanings.
According to Dr. Thieren, the first of these pertains to the moral imperative to end polio. Forty years ago, smallpox vanished from earth and created a historical precedent by removing the immense sufferings it had caused for centuries. Next came polio, with the unequivocal claim on the World Health Day on April 7, 1995: ‘Target 2000: A World Without Polio.’ Dr. Theiren states that the decision to eradicate polio once and for all was taken, not merely on scientific evidence as being more cost effective than to control it indefinitely, but also as a global conscience that polio, like smallpox, represents absolute evil to public health.
“Only a few decades ago,” Dr. Thieren states, “poliomyelitis was a singular childhood horror repeated in millions of households across the world: the sudden and brutal withdrawal by the virus of the basic physical skill a child learns to master during his/her first 12 months, “to walk”. Eradicating polio is, therefore exactly this: freeing the world from a crippling disease which condemns the most underserved children to a lifelong social death. This moral imperative is the prominent legacy of a polio-free world.”
The second meaning of a polio-free world, Dr. Thieren maintains, is the epidemiological imperative of ineluctability of eradication. “No matter how entrenched the virus is and how hard it still is to find the last vulnerable, unprotected child, there will be no way back in the effort. Eradicating polio is a target that, by definition, bears no variance: no child will be left unattended. Utilitarians may view this otherwise. Half a billion US dollars, the annual cost of the programme in Pakistan, may better be re-invested in interventions with much higher impact on child survival, such as routine immunization or breastfeeding. Let us remember that Pakistan ranges among the lowest achieving countries on Millennium Development Goals 4 and 5 associated with child and maternal mortality. But such a resource shift, right now, from polio towards other public health programmes would signify a dangerous indulgence to a “near eradication” target, which actually would be an epidemiological oxymoron,” he points out.
And then comes the third meaning. “Is eradicating illnesses a messianic vow? As we enable the ‘sixth great extinction’ of species on earth, the small string of DNA that the poliovirus is shows remarkable resilience, having for long defied the most powerful and technically equipped individuals and entities in the world. The road from half a million polio cases per year decades ago to 23 cases today hasn’t been easy, and along that long night, the programme had to reset its global target at least three times,” Dr. Thieren recommends.
In Afghanistan and Pakistan, this year alone, the Global Polio Eradication Programme has delivered half a billion doses of OPV (Oral Polio Vaccines) to approximately 50 million children during nine monthly national campaigns by mobilising 300,000 vaccination workers each time. “This represents the backbone of an even bigger logistical and operational system, with the field presence of the world’s finest polio eradication experts. The story of the collective, sustained endeavor complemented with hundreds of thousands of individual narrative accounts has yet to be told. The take-home message however, for all of us on the ground in Pakistan and Afghanistan is very simple: polio eradication works; polio eradication is much more than just a medical jargon and a “doctor thing”; it belongs to religious leaders, army personnel, security experts, peace negotiators, policy makers, legislators, and the executive; it stands on the shoulders of courageous anonymous professionals who, every morning are not going out to work, but with a resolve to fight,” Dr. Thieren states.
Most importantly, polio eradication in its last mile requires the integral ownership and undertaking of the tasks by the community, in disregard to any top-down programmatic intrusion from the outside. The “community-based vaccination” approach is at the core of our countdown to zero strategy in the next several weeks,” the WHO chief maintains.
In conclusion, Dr. Thieren states “it is paradoxically when there will be no more poliovirus, that the world will have reached its top capacity and savoir-faire to eradicate it. This ability will transfer to future eradication efforts in malaria and measles eventually. Eradication overall is a humanitarian and epidemiological imperative, and it is an imperative in its own. It reassures a constantly worried world about emerging health threats that actually deadly diseases can also be forced out. This is what the world is celebrating on World Polio Day.”
