Polio has reappeared in 14 countries and is rising in Pakistan casts doubt on global eradication hopes
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Pastor Dale Morgan
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Jul 20, 2011, 8:20:42 PM7/20/11
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Plagues,
Pestilences and Diseases
Polio has reappeared in 14 countries and is rising in
Pakistan casts doubt on global eradication hopes
Chad and DR Congo among 14 countries on brink of health emergency,
warns former UK medical chief
* Sarah Boseley, health editor
* guardian.co.uk, Wednesday 20 July 2011 17.41 BST
Polio has reappeared in 14 countries and is rising in Pakistan,
one of four countries where it is still endemic, experts warn.
Photograph: Divyakant Solanki/EPA
The hope of eradicating polio from the planet by the end of 2012
is in serious doubt, a monitoring committee is warning, because
the virus is resurgent in places where it had disappeared and
cases continue to rise in Pakistan, one of four countries where it
is endemic.
"It is on a knife-edge," said Sir Liam Donaldson, the UK's former
chief medical officer who now chairs the independent monitoring
board of the Global Polio Eradication Initiative. "Success would
be a terrific achievement. To eliminate only the second global
epidemic disease [after smallpox] would be a tremendous public
health triumph, but failure to do so would have enormous
consequences. It is a disease that not only affects individuals
and families but erodes economic prosperity in some of the
countries affected."
Donaldson considers the continued transmission of polio to be "a
global health emergency". Eradicating the disease, he said, "is
still feasible but more urgency is needed to complete it. The plan
to stop transmission by the end of 2012 is not on track."
The latest report from Donaldson's board, set up last year to
monitor and guide the eradication effort, shows that a key target
was missed at the end of last year. By the end of 2010, polio
should have been stamped out in countries where there had been a
resurgence after elimination. It did not happen. The report shows
that polio has reappeared in 14 countries.
"The milestone was conclusively missed and the programme must be
judged to have performed poorly in this regard," it says.
The biggest concerns are for Chad and Democratic Republic of
Congo, with 59 and 80 cases respectively this year. "We are deeply
concerned by the situation in DR Congo," says the report. "The
worrying picture revealed by vaccination and surveillance data is
confirmed by observations of widespread dysfunction on the ground.
"Leadership from the highest level is key for polio eradication
and we urge the active involvement of the president in this case.
Without his active involvement, we cannot believe that the
necessary step-change will occur to interrupt polio transmission
in DR Congo."
Polio in Chad, says the report, is widespread and the situation is
"of great concern". An emergency action plan has been put into
place, but not as quickly as the monitoring board had hoped. The
World Health Organisation and Unicef have sent in 100 extra staff
to boost vaccination efforts. "The difficult and crucial challenge
now is to assemble this new surge of staff into a coordinated
functioning team with the utmost speed."Both these countries and
12 others where polio cases have been identified had stopped
transmission for at least six months. Four countries have not yet
succeeded in doing that – in India, Nigeria, Afghanistan and
Pakistan, polio is still endemic.
Excellent progress has been made in India, where mass vaccination
days involving more than a million volunteers brought down cases
by 94% between 2009 and 2010, from 741 to 42. In the first six
months of this year, there has been just one case.
Afghanistan has been doing relatively well in spite of
difficulties caused by conflict. Nigeria made excellent progress
in 2010, but there has been a loss of momentum following
elections, the report says. The leadership is committed, but Kano,
in the north, where the Muslim population a few years ago refused
immunisation because of false rumours that the vaccine would
sterilise their children, "remains a smouldering risk that could
yet undermine the whole eradication effort," the board says.
But in Pakistan, cases are going up, not down and conflict and the
dismantling of a national ministry of health in favour of local
control does not help. "It still looks like it will be the last
country to stop transmission, putting its neighbours and the
global effort in jeopardy," says the report. "The country needs to
muster up relentless energy to really get to grips with the
challenges of implementing its emergency action plan."