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Carrots (and sticks) needed for the polio end game
- Nick Wilson, Osman Mansoor (26 May 2005)
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Polio Eradication
- Anne O Abe (7 June 2005)
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Nick Wilson, Senior Lecturer, Public Health Wellington School of Medicine, Otago University, Wellington, New Zealand, Osman Mansoor
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A BMJ editorial highlights the need for WHO to reassert its global role [1] and in the same issue of the journal a news item details the spread of polio to Yemen and Indonesia [2]. There is no doubt that WHO is critical to addressing global public goods [3] such as polio eradication (and previously smallpox eradication). By 2003, national efforts coordinated and supported by WHO and other partners, had eliminated polio circulation from all but six countries. But why, two years later, does polio eradication look more challenging now, with polio returning to other countries and the six still endemic? Possibly, the remaining polio endemic countries have lacked the political will and the continued external funding for polio control (that would stop with elimination) has been a greater incentive than achieving the elimination goals. This failure highlights the need for WHO to have a stronger mandate when the actions of some Member States threaten the well-being of others. This is a challenging idea, but one that is now necessary in a globalised world, as was recognised during the SARS outbreak. The rapid control of SARS in 2003 was largely driven by the impact on national economies of WHO applying a “local SARS transmission” label. Can WHO and the global community repeat this for polio (eg, by issuing travel advisories)? Travel restrictions (eg, requiring evidence of immunity) could limit spread while increasing the political will for a country to achieve elimination. Can “smart sanctions” that only affect the country’s decision-makers be applied? Governments and other organisations need to provide more funding and WHO needs to continue providing support and technical assistance [4]. But given the importance and urgency of eradicating polio (as well as the implications for other global programmes), is it not time to consider other global policy instruments? References (1) Ruger JP, Yach D. Global functions at the World Health Organization. BMJ 2005;330:1099-1100. (2) Dyer O. WHO's attempts to eradicate polio are thwarted in Africa and Asia. BMJ 2005;330:1106. (3) Smith R, Woodward D, Acharya A, et al. Communicable disease control: a "Global Public Good" perspective. Health Policy Plan 2004;19: 271-8. (4) Aylward RB, Linkins J. Polio eradication: mobilizing and managing the human resources. Bull World Health Organ 2005;83:268-73. Competing interests: Both authors have previously undertaken work for the WHO relating to polio eradication. |
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Anne O Abe, Medical Practitioner Nigeria
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As the world watches with growing concern the WHO global eradication initiative being frustrated by its epidemic and endemicity in various countries. I am able to draw upon my short experience as a medical practitioner in Nigeria and especially during the one year i spent as a inner community doctor in an area with new outbreaks of polio. Various valid reasons have been highlighted including reduced sero- conversion factor in tropics because of the instability of the oral vaccine but all these can be easily solved via the multiple mass immunisations with continual vaccines being given till 5 years of age as currently being done now. The major factor which i would like to re-emphasise was glossed over is the refusal of vaccine administration by parents and guardians of children. This was brought about as rightly stated by the statement by some community leaders that it brought about sterility and HIV. The fact that this was acheived in low literacy areas should also be noted as 100% mass immunisations take place in highly literate areas. Another thing that has not been mentioned is sometimes political motivations behind such statements and politics is usually behind such propanganda in such environments. Of course low literacy and high poverty areas are usually best target for such. Based on my experience (limited it may seem)i will like to share a few of my recommendations and thoughts on this issue. I realise that policies earmarked for such disease eradication projects do not fully put into persepective the local or cultural factors. These include the impact of community leaders on policies as a parent-child relationship is still being mantained between the communities and these leaders whom are usually seen to be better enlightened and educated. This is not the norm in the western environment and as a lot of these policies are mapped out by people from western world with little or no understanding of such local factors, things get complicated. For any policy or new development to work the involvement of the leaders must be sought from the onset even before reaching into the community. Another point is the importance of involvement of health workers from these parts of the world in such global bodies as the WHO. Of great importance is improving literacy programmes around the world. We cannot continue to pretend it does not affect us as the world is a global village and travel which occurs means we can not isolate ourselves in our certain unaffected parts of the world. A little more education and knowledge would help people to better understand the physiology of the human body. Fertility is very important in African culture and for many better paralysis than sterility. With all this being said, i know a lot is being done at the moment and even at this a lot of community leaders are doing their best to disabuse the notion of a harmful vaccine. Mass immunisations are going on and health workers are doing a lot to educate people, door to door immunisation despite diificulties are being done. Policies have to be adapted to each locality and culture as a country ( such as Nigeria) might have many different cultures with varying beliefs and pratices might have to have different programmes marked out for the same initiative. This may sound so cumbersome at first but it is easier when we make the people feel involved in their decisions through their leaders. Competing interests: None declared |
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