END POLIO NOW - June & July, 2011 update

Polio resurgence casts doubt on global eradication hopes
Chad and DR Congo among 14 countries on brink of health emergency, warns former UK medical chief.

The hope of eradicating polio from the planet by the end of 2012 is in serious doubt, a monitoring committee is warning, because the virus is resurgent in places where it had disappeared and cases continue to rise in Pakistan, one of four countries where it is endemic. "It is on a knife-edge," said Sir Liam Donaldson, the UK's former chief medical officer who now chairs the independent monitoring board of the Global Polio Eradication Initiative. "Success would be a terrific achievement. To eliminate only the second global epidemic disease [after smallpox] would be a tremendous public health triumph, but failure to do so would have enormous consequences. It is a disease that not only affects individuals and families but erodes economic prosperity in some of the countries affected."

Donaldson considers the continued transmission of polio to be "a global health emergency". Eradicating the disease, he said, "is still feasible but more urgency is needed to complete it. The plan to stop transmission by the end of 2012 is not on track." The latest report from Donaldson's board, set up last year to monitor and guide the eradication effort, shows that a key target was missed at the end of last year. By the end of 2010, polio should have been stamped out in countries where there had been a resurgence after elimination. It did not happen. The report shows that polio has reappeared in 14 countries. "The milestone was conclusively missed and the programme must be judged to have performed poorly in this regard," it says.

The biggest concerns are for Chad and Democratic Republic of Congo, with 59 and 80 cases respectively this year. "We are deeply concerned by the situation in DR Congo," says the report. "The worrying picture revealed by vaccination and surveillance data is confirmed by observations of widespread dysfunction on the ground. "Leadership from the highest level is key for polio eradication and we urge the active involvement of the president in this case. Without his active involvement, we cannot believe that the necessary step-change will occur to interrupt polio transmission in DR Congo."

Polio in Chad, says the report, is widespread and the situation is "of great concern". An emergency action plan has been put into place, but not as quickly as the monitoring board had hoped. The World Health Organisation and Unicef have sent in 100 extra staff to boost vaccination efforts. "The difficult and crucial challenge now is to assemble this new surge of staff into a coordinated functioning team with the utmost speed."Both these countries and 12 others where polio cases have been identified had stopped transmission for at least six months. Four countries have not yet succeeded in doing that – in India, Nigeria, Afghanistan and Pakistan, polio is still endemic.

Excellent progress has been made in India, where mass vaccination days involving more than a million volunteers brought down cases by 94% between 2009 and 2010, from 741 to 42. In the first six months of this year, there has been just one case. Afghanistan has been doing relatively well in spite of difficulties caused by conflict. Nigeria made excellent progress in 2010, but there has been a loss of momentum following elections, the report says. The leadership is committed, but Kano, in the north, where the Muslim population a few years ago refused immunisation because of false rumours that the vaccine would sterilise their children, "remains a smouldering risk that could yet undermine the whole eradication effort," the board says.

But in Pakistan, cases are going up, not down and conflict and the dismantling of a national ministry of health in favour of local control does not help. "It still looks like it will be the last country to stop transmission, putting its neighbours and the global effort in jeopardy," says the report. "The country needs to muster up relentless energy to really get to grips with the challenges of implementing its emergency action plan." Sarah Boseley, guardian.co.uk

Nowhere to Go: So What if it Rains?

The biggest public health effort in the country achieved a major milestone in July when it completed six months without any polio case — the longest period in the history of the campaign. The last incidence of polio reported on January 13, 2011 in Howrah, West Bengal was the lone case this year so far.

India: There have not been any cases reported in India for six months. The most recent case had onset of paralysis on 13 January in West Bengal (WPV1). The latest SIAs were SNIDs which took place beginning 26 June in parts of West Bengal, Uttar, Pradesh, Bihar, Delhi and other high-risk areas. The recently released IMB report commended India on its progress, but stressed the need for continued vigilance especially as the high season for poliovirus transmission approaches. An aggressive strategy to ensure the cessation of polio transmission was recommended by the Indian Expert Advisory Group (IEAG) at their meeting on 13-14 July. The IEAG agreed on a set of measures designed to ensure that no polio cases are overlooked and no children are missed by vaccinators. The Government of India pledged its ongoing support at the IEAG meeting and vowed to do whatever it takes to finish off the virus.



Citing dramatic gains achieved with polio vaccines, Prime Minister David Cameron joins Bill and Melinda Gates to call on world leaders to finish the job

UK Government Doubles Polio Funding - Bill Gates Progress for Rotary's US$200 Million Challenge for polio eradication
Eradicating polio will take renewed resolve, says Gates - Rotary International News -- 7 June 2011 by Ryan Hyland

Bill Gates addressed Rotarians during the third plenary session of the 2011 RI Convention 24 May. Rotary Images/Monika Lozinska-Lee
Rotary International on Facebook Bill Gates, cochair of the Bill & Melinda Gates Foundation, praised Rotary for its continued success in the effort to eradicate polio, but cautioned that Rotarians will need to redouble their efforts to keep the disease from spreading -- and threatening hundreds of thousands of children.

Gates, the keynote speaker at the third plenary session of the 2011 RI Convention, 24 May in New Orleans, Louisiana, USA, said that because of Rotary, there are many places in the world where polio is no longer considered a threat. “That’s a blessing and a curse,” said Gates. “The blessing is that in many places, polio is a disease of the past. The curse is that it is now harder for us to raise awareness that, in some places, polio is also a disease of the present. If we fail to help leaders around the world understand this, polio is certain to be a disease of the future.”

Gates praised Rotary for reducing the incidence of polio by more than 99 percent worldwide since 1988. “Your work has brought us so far,” he said. “I’m so proud to be a partner in the work that Rotary has been doing to eradicate polio.” Gates noted that only one case of polio had been reported in India this year, as of March. “India is approaching zero cases,” said Gates. “None of this would have been remotely achievable had it not been for Rotary. We would not be where we are without you. Nor can we get to where we’re going without you.”

Gates said that he and his wife, Melinda, have made eradicating polio their foundation's top priority. With the world on the threshold of eradication, the hard work really begins, he said. “Polio eradication has been our single biggest investment in recent years, as far as innovation and creativity. The last 1 percent will be the longest and hardest 1 percent,” he said. “It will require more work and more commitment than ever before. Without the redoubled effort of everyone in this room, and your fellow Rotarians around the world, we will not succeed. Redoubling is crucial to ending polio.” The Gates Foundation has awarded two grants totaling US$355 million to Rotary in support of its work in eradicating the disease. Rotary has responded with Rotary's US$200 Million Challenge . To date, Rotarians have raised $173.2 million for the challenge. Gates said he plans to work with Rotary leadership to keep polio front and center in the public eye. “You have helped so many people understand that we are ‘this close.’ I challenge you to make your voices louder.”

Countries including Canada, the United Arab Emirates, the United Kingdom, and the United States have all increased their investment in the eradication effort. Gates attributed that success to the pressure Rotarians have put on the leaders of those countries. But he noted that with a funding gap of $400 million next year for the Global Polio Eradication Initiative , it is no time to let up. “If we fail, the disease will not stay at its current low level,” he said. “It will spread back into countries where it’s been eliminated, and will kill and paralyze hundreds of thousands of children who used to be safe.” Gates said that the monuments Rotarians have illuminated with the End Polio Now message are powerful images. “But ultimately, the most important monument won’t be the one we illuminate,” said Gates. “It will be the one we create.”

As of 31 May, Rotarians have raised about $174.7 million for Rotary's US$200 Million Challenge. These contributions will help Rotary raise $200 million to match $355 million in challenge grants received from the Bill & Melinda Gates Foundation. The resulting $555 million will directly support immunization campaigns in developing countries, where polio continues to infect and paralyze children, robbing them of their futures and compounding the hardships faced by their families.

As long as polio threatens even one child anywhere in the world, children everywhere remain at risk. The stakes are that high.

Source: Rotary International Convention: New Orleans - 2011

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