Thursday, April 6, 2017

We have never been this close to wiping out polio

This was originally published on the Huffington Post on November 23, 2016.

PARIS, France — Could the Global Polio Day we observed last week be the last such day with actual polio cases?

Participants at a World Polio Day event sponsored by Sanofi Pasteur and Rotary International at the Pasteur Institute here last week, all of them deeply invested in the fight against polio, heard experts say it may well be so, and that the disease could be eliminated in 2016 or 2017.

It is clear that the world is tantalizingly close to eliminating polio. As of last week, there were only 27 remaining cases of wild poliovirus — 15 in Pakistan, 8 in Afghanistan and 4 in Nigeria.  We are on the brink of eliminating the second human disease in history (smallpox, in 1980, was the first).

It is true that all three countries have security challenges. But in Pakistan, the country with the largest number of remaining cases, the security situation has improved markedly since 2014.

“There were close to half a million kids not reachable due to insecurity in 2014,” said Dr. Mufti Zubair Wadood, technical officer for the Global Polio Eradication Initiative at the World Health Organization (WHO) and former head of the WHO polio program in Pakistan. “Since then, the situation has been improving and right now there are almost no areas of the country that are not accessible. That has resulted in a significant drop in the number of cases. Pakistan deserves a huge pat on the back at a time when things were dire.”

Latif, one of five people honored at the event as a “polio hero,” agrees that security is much less of a concern. He should know. A polio worker for over 20 years, he was shot in the leg by extremists in 2012 while carrying out his work. His colleague was killed. Latif was hospitalized for three months and had 11 metal rods inserted into his leg. Today, fully recovered, he continues his work eradicating polio in northwestern Pakistan.

We could not have gotten this far without Latif and the 20 million volunteer vaccinators in the world, some of whom have repeatedly risked their lives to get vaccines into remote and dangerous regions. Meet Latif in this video from Sanofi Pasteur/AKS Films.

So when will polio be eliminated? Wadood believes the next six months presents an excellent opportunity because this cooler period is when the vaccine works best and the virus is not transmitting at a high rate.

“It’s not just the number of polio cases, it’s also the number of infected countries and the sub-national situations in Afghanistan and Pakistan, which have never been so encouraging,” said Wadood. “If good campaigns are implemented in the next 3-6 months, there is no reason we cannot stop it in late 2016 or early 2017.”

The eradication of polio will not only be a global health success but also a global economic success. Eradication is expected to save between $40 and $50 billion during the period 1988 to 2035, according to Dr. Kimberly Thompson, professor of Preventive Medicine and Global Health at the University of Central Florida and president of Kid Risk, who has done economic analysis of the impact of polio. “Polio eradication represents a gift from our generation to future generations,” she said.

Thompson also said that the polio eradication campaign could provide a template for the eradication of measles, rubella and other diseases. India is the best example of that: It became polio-free in 2011 and is now applying the lessons learned to neonatal tetanus, measles and rubella.

The polio eradication campaign is the largest public health program in history. For nearly 30 years, national governments, WHO, Rotary International, the U.S. Centers for Disease Control and Prevention and UNICEF have worked on this issue. More recently, the Bill and Melinda Gates Foundation became a principal partner.

Sanofi Pasteur is, by far, the biggest supplier of polio vaccine in the world. It has provided 6 billion doses of the oral polio vaccine over the last decade and more than 1 billion doses of the inactivated polio vaccine, through injection, which will protect everyone once polio is eradicated.

But even after eradication, polio vaccination will have to continue for years, even decades, said David Loew, executive vice president of Sanofi Pasteur, to be 100% sure that we don’t have a resurgence of the virus. Loew said that Sanofi is even thinking about building a second factory (in addition to the one near Lyon), and that it takes seven years between the decision to build a factory and the day when vaccine is produced. Clearly, polio will continue to focus our attention for years to come, even after eradication.

Victory may be near but Latif, the Pakistani polio hero, is not relenting in his war against the disease. I asked him if he considered giving up after extremists shot him in 2012. “No, I never thought of that,” he said. “As a matter of fact, I don’t connect the pain I felt with the work I do. They are two different things in my mind.”

“I want the children of my country to be healthy and protected from polio. I have participated in this fight from the beginning and I want to continue to the end, to see a polio-free Pakistan.”

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