World could be declared free of polio by 2018

BMJ 2013; 346 doi: (Published 12 April 2013) Cite this as: BMJ 2013;346:f2373

Re: World could be declared free of polio by 2018

Gulland’s article is optimistic about the feasibility of global polio eradication by 2018 and highlights the need to bridge the current funding gap and mobilise the resources required. Given the background of funding for polio eradication so far especially with funding agencies like Bill and Melinda Gates Foundation in full support, finance though very important is unlikely to be a constraining factor which impedes eradication.

More importantly we need to clearly identify the focus areas for action and designate the responsibilities to specific agencies within the Global polio eradication initiative. In context of all the three endemic countries of Pakistan, Afghanistan and Nigeria, the most critical areas for success or failure would be effective and adequate political advocacy and social mobilisation. Based on its experience as well as expertise, UNICEF is the best candidate for social mobilisation and political advocacy with Support from Rotary International for all the three countries. Even for vaccine logistics and cold chain issues including remote areas UNICEF should be given the leadership role.

If GPEI is able to garner political support and ensure adequate social mobilisation including support of religious leaders, two third of our job in these three endemic countries would be complete.

This would leave only the issue of micro-planning, training and monitoring of the vaccination which can be handled by WHO along with the Ministry of Health and Family Welfare of each country.

Accountability of all the manpower involved at each level would be a critical component as mentioned by Dr Hamid Jafari, head of global initiative at WHO, Geneva. This accountable manpower was in the form of an independent network of more than 300 field Surveillance medical officers (SMOs) in India who proved to be a major factor in the successful interruption of polio virus transmission in India. The remaining three endemic countries would need to identify such accountable manpower within their countries or accept consultants from other countries to achieve the requisite critical mass of accountable manpower.

Last but not the least, GPEI cannot afford to lose focus and build on the gains made in India which was an endemic country till recently. The polio initiative in India needs to mainstream its core polio manpower of SMOs into routine immunization strengthening initiative of Government of India at a very rapid pace. MOHFW has launched the Immunisation Technical Support Unit (ITSU) to strengthen the technical and managerial capacity of the National Immunization team of Government of India. GPEI should facilitate active collaboration of the PEI staff and ITSU for routine immunisation and also implement the draft “endgame strategic plan” in India on priority. Stregthening routine immunisation rapidly would help to prevent re-establishment of polio virus transmission, stop VDPV circulation and also provide a delivery mechanism for IPV switch from OPV in the longer term in India. All these steps would enable meeting the deadline of 2018 for a polio free world successfully.

Competing interests: No competing interests

09 May 2013
WT Research Scholar
University College London
Dept of Epidemiology and Public Health,UCL,