Turning the Corner on Polio in 2012

Working to support the effort to rid the world of polio has taken me to some exotic places. But earlier this month, it took me to Washington, DC (I suppose you could argue this is also quite an unusual spot) to talk with policy makers about the historic opportunity we have to end polio forever. 

My conversations with lawmakers gave me a chance to discuss some of the doubts people have expressed about whether we can really do this. But it also provided the opportunity to bring lawmakers up-to-speed on the results of important changes in the Global Polio Eradication Initiative’s (GPEI) approach—including cool new technology being used and the increased engagement on the part of governments in the countries where polio transmission continues.

In my opinion, the changes and progress in 2012 have made for the most convincing case yet that ending polio is possible—and is one of the most concrete accomplishments possible for global health.

For more than 10 years, we have been 99 percent of the way toward ridding the world of polio. Since then, every few years the global community would vow that year would be the year when polio transmission would stop.

However, 2012 is notably different from the earlier stagnation in progress. And while the global program hasn’t stopped transmission of the wild polio virus everywhere as some had predicted, it did close a big gap in that last one percent when India became polio-free early in the year after a long and hard battle to protect more than 172 million children under the age of five from polio. This was incredible tough terrain in which to run thousands, if not tens of thousands of vaccination campaigns. So, the lessons learned from India’s success are serving as a great guide for what’s needed in the remaining three countries where polio transmission persists—Nigeria, Pakistan and Afghanistan.

There’s no doubt that these countries aren’t easy places to get rid of the disease. There are a number of factors that need to be in place including improved campaign quality, meeting the program’s global funding needs, and anticipating political challenges. 

I heard from U.S. lawmakers that the news regularly coming out of Afghanistan and Pakistan has led to reasonable concerns about the role insecurity plays in being able to reach children with vaccines. But in the last 11 months, incredible efforts are being made in these two countries by government officials, religious and community leaders and non-government organizations to negotiate access to children in hard-to-reach places. 

And those efforts are paying off. 

The polio program has been partnering with a number of NGOs to conduct negotiations to secure access to children, leading to breakthroughs in the past few months. In Afghanistan, the average number of inaccessible children in thirteen of the highest risk districts of the country has been reduced by more than half, from nine percent in June 2012 to 3.4 percent this November. And in the Terah Valley in Pakistan, where children hadn’t received vaccines in three years, approximately 30,000 children were reached with the polio and other critical vaccines during a vaccination campaign earlier this fall.

On the other front, in Nigeria, while cases have actually gone up this year, there is a full-scale effort to revamp the program, with many changes based on what vaccinators in India implemented to great success. Included in these changes are decreases in the size of vaccination teams and the addition of female vaccinators, tracking of nomadic populations, rigorous microplanning and scaling up of additional staff to help with all of these activities. 

Another major innovation that is leading to early reports of impressive progress is the work on GIS mapping and GPS tracking to improve polio campaign planning and performance.  (It’s a really ingenious use of the technology that you can learn more about here.) GPEI’s focus on using the polio program to increase routine immunization is ensuring that the polio program has an even broader long-term impact on the population.

The Independent Monitoring Board of the GPEI also notes the positive changes in a report released last week and their conclusion that the GPEI “has never been in a stronger position” reflects what I’m seeing too.  Their assessment about what comes next for the history books is telling: “The time is momentous for public health history. A final concerted effort could indeed mean writing the story of polio’s last stand.” 

I couldn’t agree more.