Ashok Mahajan: Return of the polio virus?

The $700-mn funding gap in the global campaign to eradicate polio intensifies the risk of relapse in polio-free India, other nations

Twenty two months and not a single case of wild polio virus reported in India. Although some may consider this reason enough to celebrate the eradication of polio from the country, the sobering fact remains that it’s still not the right time to uncork the bubbly. On World Polio Day today (October 24), the real cheering can only happen when the last three polio-endemic nations – Afghanistan, Pakistan and Nigeria – officially end up being declared polio-free nations. Until this happens, all nations that eradicated polio are at risk of re-establishing the transmission of the virus via its “importation” from endemic nations.

Unfortunately, this risk has intensified due to the huge $700-million funding gap that bedevils the global polio eradication programme. With the scourge having been eradicated in most countries, donor fatigue has crept in, especially after the global economic recession. Yet this is the time when continued commitment from donor countries is imperative. If global eradication falters and the virus rebounds from its bastion in the three endemic nations, up to 200,000 children a year could end up being paralysed. Such a horrendous eventuality is something the world simply cannot countenance. Moreover, re-eradicating polio from nations where the virus re-emerges would then need higher funding outlays than required at present.

Naturally, funds from every donor play an important role in bridging the deficit and saving crucial lives. During the United Nations General Assembly session in New York in September 2012, Rotary International had committed an additional $75 million over the next three years for the Global Polio Eradication Initiative (GPEI). GPEI was launched in 1988 by WHO (World Health Organisation), UNICEF (United Nations Children’s Fund), Rotary International, and the US Centres for Disease Control and Prevention. The partnership is now backed by the Bill & Melinda Gates Foundation and the United Nations Foundation. Since its launch, more than $9.5 billion has been invested by GPEI to eradicate polio.

Apart from the financial strain, running such a big campaign with a mammoth operational task has been both overwhelming and difficult, besides demanding extraordinary efforts and commitment from the governments and the partners involved. Given the huge $700-million funding gap, the 24-year-old global campaign to eradicate polio is at a critical stage, since new polio cases are at an all-time low, with India over the halfway mark in achieving the polio-free regional certificate. Additional funds would assist India and the endemic nations to sustain their eradication efforts towards becoming totally polio-free.

Although India’s success against polio has been hailed as a significant achievement, all polio partners are wary of the risks posed by complacency, cross-border importation, diminishing funds, any decline in commitment in the wake of “zero cases” and a perception that the polio threat is over. Keeping the challenges of the endemic nations in mind, a new donor to the polio eradication drive, Islamic Development Bank declared a $227-million loan to Pakistan in September 2012, including a $3-million grant for the polio drive in Afghanistan.

Traditionally perceived as one of the toughest terrains in the polio eradication programme worldwide, if India ends 2012 with steadfast commitment of “zero polio cases”, and moves closer to completing the three-year target, it will be in line to acquire the regional polio-free certification from WHO by 2014.

Considering India’s vast geographic spread and the diversity of cultures, the “toughest terrain” tag is not difficult to fathom. In fact, each National Immunisation Day (NID) in India is an achievement of sorts involving 225 million doses of polio vaccine, 172 million children under five throughout India’s 35 states and union territories being vaccinated via 2.5 million vaccinators, two million vaccine carriers and 155,000 supervisors.

That’s not all. In 2011, each NID was followed by seven smaller, more focused sub-national immunisation days, during which up to two million community health workers conducted massive mobilisation drives and communication campaigns focused on high-risk areas. With such mind-boggling numbers, WHO, UNICEF, the US Centre for Disease Control and Rotary International all play critical roles in supporting the polio programmes.

India’s success story has provided a new lease of life to the fight against polio, particularly in the last three nations where the virus still thrives – Pakistan, Afghanistan and Nigeria. Given regional similarities between India and Pakistan, the lessons learnt in India’s polio eradication drive have been coming in handy in Pakistan’s efforts to eradicate polio within its borders. Hopefully, these efforts will finally fructify in the total eradication of polio from Pakistan and the other endemic nations. When that happens, the once-dreaded scourge will finally vanish into extinction just as the smallpox virus did decades earlier.

Prof Kimberley M Thompson whose study on polio eradication was published in the reputed medical journal, The Lancet, says: “…Worldwide eradication of wild polio viruses is likely to yield substantial health and financial benefits, provided we finish the job.” And cautions, “…wavering commitment will lead to a failure to eradicate, greater cumulative costs, and a much larger number of cases”.

Immense efforts – both in terms of science and human resources – have made it possible to bring the dream of a polio-free world closer to reality. The shortfall in funds at this crucial hour – with just three endemic countries remaining worldwide – could play spoilsport. A disease that is almost on the verge of elimination may bounce back… unless global leaders and nations come together quickly to fill this gap.

The author is a Member of Rotary International’s PolioPlus Committee and Trustee of The Rotary Foundation