WHO's attempts to eradicate polio are thwarted in Africa and Asia
BMJ 2005; 330 doi: https://doi.org/10.1136/bmj.330.7500.1106 (Published 12 May 2005) Cite this as: BMJ 2005;330:1106All rapid responses
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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.
Competing interests: No competing interests
Polio Eradication
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
Competing interests: No competing interests