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World could be declared free of polio by 2018

BMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f2373 (Published 12 April 2013) Cite this as: BMJ 2013;346:f2373
  1. Anne Gulland
  1. 1London

Progress on eliminating polio has accelerated so much in the past year that the world could be declared free of the disease by 2018, according to the World Health Organization polio programme.

The Global Polio Eradication Initiative (GPEI), a public-private partnership spearheaded by WHO, has put together a six year strategy predicting that the last case of wild polio virus will occur by the end of 2014.

After that, a period of containment and certification will take place and if no further cases arise, the world will be declared free of a disease that just 25 years ago was affecting hundreds of thousands of people a year.

At a press briefing to launch the six year plan, Jay Wenger, director of the polio eradication team at the Bill and Melinda Gates Foundation, said: “When the world has been declared polio free, the job will be done.”

There were 223 cases of polio in 2012, compared with 650 in 2011. So far this year, there have been just 18 cases reported in the three remaining endemic countries (Pakistan, Afghanistan, and Nigeria), compared with 38 in the same period last year.

Hamid Jafari, director of polio eradication at WHO, said: “2012 saw the lowest number of cases ever reported in the world, and this presents a real opportunity to complete the task of polio eradication.”

Once the last case of polio has been declared, the oral polio vaccine will be replaced by the inactivated polio vaccine, which is used in developed countries. The oral vaccine is more effective in endemic countries, but has a risk of polio transmission, particularly where immunisation levels are low, because the vaccine is based on a weakened form of the virus. Since 2000, 600 cases of paralysis have been caused by vaccine derived polio virus.

The inactivated polio vaccine is more expensive than oral polio vaccine, and WHO is hoping for the production of a hexavalent vaccine, including tetanus, diphtheria, pertussis, hepatitis B, and Haemophilus influenzae type B. Fifteen to 20 years after the world is declared polio free, immunisation against the disease would cease, said Steve Cochi, senior adviser on immunisation for the US Centers for Disease Control.

The successful eradication of polio in India, which has seen no cases since February 2011, gave the global health community the confidence to aspire to a polio free world. India was seen as a country that was highly unlikely to wipe out the disease because of its large urban population of poor people living in close quarters.

Jafari said that when India came off the list of polio endemic countries, it became clear that it was not technical or biological reasons that made a difference to polio eradication, but rather accountability, strong management of immunisation strategy, and political will.

Despite shootings of polio vaccination workers in Pakistan and Nigeria, progress on eliminating the vaccine accelerated last year because of intensified efforts to identify the last remaining areas that had not seen vaccination campaigns, said Cochi.

“In Nigeria, there has been a process of identifying thousands of small villages and settlements that have been outside the programme. Literally thousands of additional staff have been hired or deployed by WHO or Unicef,” he said.

However, a lack of funding could put the plan at risk. The GPEI says that its six year plan will cost $5.5bn (£4.2bn; €3.6bn), $3.5bn of which has already been raised. Robert Scott, chair of the polio committee at Rotary International, a charity that has campaigned on polio elimination since 1985, said that donors such as the Gates Foundation had been generous but it was up to governments to put their hands in their pockets.

“We are hopeful that the US government will help and we have strong vibes from Germany and from the [UK] Department for International Development,” he said.

Notes

Cite this as: BMJ 2013;346:f2373