Polio Eradication: Urgent Need for Action

Twenty-five years after we set out to achieve one of the most ambitious public health goals ever, we are within reach of the finish line: polio eradication.
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Twenty-five years after we set out to achieve one of the most ambitious public health goals ever, we are within reach of the finish line: polio eradication.

As a medical student in the late 1950's, I remember caring for children paralyzed by polio, including those forced to live in "iron lungs" because polio had paralyzed the nerves required to breath. Virtually everyone knew someone whose family had been affected by the disease.

Fortunately, development of vaccines by American scientists Jonas Salk and Albert Sabin enabled us to rid the U.S. of polio by 1979.

In 1988, when polio still occurred in 125 countries and paralyzed 350,000 people annually, health ministers from around the world passed a resolution at the World Health Assembly (WHA) calling for eradication. Since then, the U.S. has been working with partners to free everyone, everywhere, from polio forever, and I am proud to have been a part of the effort from the beginning.

The resolution created a remarkable public-private partnership -- the Global Polio Eradication Initiative (GPEI) -- led by the World Health Organization, Rotary International, the US Centers for Disease Control and Prevention (CDC), and UNICEF. Its impact has been extraordinary. Today, all but three countries have interrupted wild poliovirus transmission, and in 2012 we recorded just 223 cases -- fewer than ever before. We'd always thought India would be the last country to eliminate polio; today, it's been polio-free for more than two years.

The U.S. has played a major role in this fight, with CDC at the helm. CDC has established an unprecedented global network of laboratories, provided technical experts and more than 1,800 volunteers to polio-affected countries, and contributed three-quarters of the US' $2.1 billion investment in polio eradication. Director Dr. Thomas Frieden activated CDC's Emergency Operations Center to strengthen the agency's eradication efforts.

CDC is joined in this work by the US Agency for International Development and by other US-based organizations, including Rotary International and the Bill & Melinda Gates Foundation. Both have contributed more than $1 billion and, in Rotary's case, countless volunteer hours.

The changing situation as we near eradication forces us to revise our strategies. For example, the program will introduce an inactivated injectable vaccine to eliminate the rare cases of paralysis caused by the existing oral vaccine. In addition, operational barriers like weak infrastructure, vaccine refusals and insecurity are obstacles to reaching kids in the final pockets.

In response, the GPEI recently developed the Polio Eradication and Endgame Strategic Plan 2013-2018. Building on years of progress and lessons learned, the plan tackles polio on several fronts: it seeks to eliminate both wild and vaccine-derived poliovirus, while strengthening routine immunization to protect against other diseases. The plan will require $5.5 billion through 2018, three-quarters of which have already been pledged.

At the end of May, on the 25th anniversary of the GPEI's founding, the WHA endorsed the plan. I had the privilege of joining nearly 500 other scientists and technical experts in endorsing it in April.

We are closer than ever to ending polio. Insufficient human and financial resources now could compromise our chance of success -- and the longer it takes, the more expensive it will be. The U.S. must continue its leadership and commit additional funding to achieve the goal.

Twenty-six years ago, colleagues and I published an article that concluded: "global eradication of poliomyelitis is inevitable; the only question is whether we will accomplish it or pass on the needed action to our successors. We believe we should act now to leave the legacy of a poliomyelitis-free world for our children." That statement is just as true today. We must act now.

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