Polio eradication: a complex end game

Like the skipper of an ageing rust bucket trying to get to port before the boat goes under, the Global Polio Eradication Initiative is ploughing through choppy seas in its effort to stamp out polio and end a mission that began more than two decades ago. As the vessel lurches uncertainly on, a Greek chorus of commentators has raised questions about everything from the choice of vaccine and the technical strategies the campaign has used to the very wisdom of pursuing the goal of eradication.

These questions are important because they cast light on the long and tortuous route that the polio eradication programme has followed since 1988, when the World Health Assembly passed a resolution declaring it was committed to eradicating polio by 2000. That deadline and a subsequent one have been missed, and a third deadline of the end of 2012 will probably be missed as well. Eradication seems both tantalisingly close and elusively distant. As it becomes harder to maintain the funding and government engagement necessary to keep the campaign going at the frenetic pace it has kept for several years now, there is a danger that the gains made over the past two decades will be lost, and the poliovirus, largely confined to pockets in South Asia and western and central Africa, will again entrench itself across swathes of the globe.⇓ ⇓

The initiative’s key partners—WHO, Unicef, US Centers for Disease Control and Prevention, Rotary International, and the Bill and Melinda Gates Foundation—have responded by increasing pressure on governments in polio affected countries to intensify their immunisation and surveillance efforts. However, the response …