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U.S., South Central Asia Combat Polio Through Partnerships

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Joint effort with Islamic conference makes eradication possible

By Carrie Loewenthal Massey
Special Correspondent

Washington - A new polio vaccine being implemented in Afghanistan thanks to a series of global partnerships will soon be distributed in India and Pakistan, as well as Nigeria, raising hopes of providing rapid, permanent vaccinations against polio in the nations struggling to eradicate the disease.

The new vaccine, distributed in Afghanistan starting December 15, is bivalent, protecting against two strains of the polio virus at the same time, thereby lessening the number of times a person must be vaccinated. Monovalent vaccines, protecting against one strain of the virus at a time, remain useful but require two rounds of vaccinations months apart, which creates difficulty in reaching all populations.

To deliver the vaccines, Afghanistan works with the Global Polio Eradication Initiative (GPEI), an effort spearheaded by the U.S. Centers for Disease Control and Prevention (CDC), the World Health Organization (WHO), the United Nations Children's Fund (UNICEF) and Rotary International, a global volunteer organization that began in Chicago in 1905. GPEI also receives significant support from the Bill and Melinda Gates Foundation, a private organization based in Seattle.

GPEI will have the bivalent vaccine in India, Pakistan and Nigeria by January 2010, pending licensing clearances.

Since its inception in 1988, GPEI has worked with national governments to vaccinate 2.5 billion children worldwide. Its efforts have reduced the global incidence of polio by 99 percent, going from 350,000 cases in 1988 to fewer than 2,000 cases in 2008, according to Rotary International.

Despite GPEI's success, polio remains endemic - occurring in nature - in Pakistan, Afghanistan, India and Nigeria. There are three strains of polio, but type 2 has already been eradicated; only types 1 and 3 remain. Children under 5 years of age remain the most vulnerable.

The national leadership in each of the endemic countries has pledged its support for the polio eradication effort. According to a GPEI fact sheet, India has allocated $657 million toward polio elimination for 2010 to 2012. In Afghanistan, the country's Ministry of Public Health, in partnership with the U.S. Agency for International Development (USAID), led several rounds of publicized National Immunization Days, meant to encourage communities to vaccinate their children.

Pakistan has also sought high-profile ways to educate people about polio vaccinations, such as President Asif Ali Zardari's October appointment of his youngest daughter, Aseefa Bhutto Zardari, as ambassador of polio eradication. In 1994, Zardari's late wife, the former Prime Minister Benazir Bhutto, publicly gave Aseefa the first polio vaccine drops in Pakistan when she launched the nation's first eradication campaign, using her own child to demonstrate the safety and importance of the effort. The Pakistani postal service has issued a stamp showing that 1994 vaccination alongside a picture of Aseefa today in her new role as polio eradication ambassador.

While national government support remains crucial, GPEI still faces the challenges of reaching children who live in conflict areas and dispelling fears about the safety of the vaccination that have prevented the completion of past immunization initiatives and resulted in increased numbers of infections. To overcome these obstacles, GPEI needs the endorsement of local governments, tribal leaders and religious figures.

To promote cooperation in the polio eradication effort, President Obama announced June 4 in his speech at Cairo University that the United States would partner with the Organization of the Islamic Conference (OIC) to abolish polio. The OIC is an intergovernmental group to which Afghanistan, Pakistan, Nigeria and much of the rest of the Muslim-majority nations belong. The United States and OIC officially launched the joint effort with a panel discussion December 2 at UNICEF headquarters in New York.

"Today's public launch of the U.S.-OIC cooperation on polio eradication represents a major step forward," said Abdul Wahab, ambassador to the Permanent Observer Mission of the OIC to the United Nations in New York, in his introductory remarks.

The OIC collaboration boosts efforts to supervise the vaccination process in hard-to-access, conflict-ridden areas, said Dr. Bruce Aylward, director of GPEI at WHO. OIC has already begun to secure the necessary community-level political and religious support for polio vaccination in Afghanistan, Pakistan and Nigeria.

According to an OIC fact sheet outlining its initiatives on polio eradication, the organization has spoken with the presidents of these countries about publicly distributing a fatwa issued in August by the International Islamic Fiqh Academy. The fatwa, or religious edict, calls for parents to vaccinate their children and explains that the Quran commands the protection of children against preventable disease.

Successful polio eradication also depends on trust among OIC member states, the United States, and all participating partners, Ambassador Frederick Barton, the U.S. representative on the U.N. Economic and Social Council, explained in his opening remarks at the UNICEF panel discussion.

"I'm here to really offer on behalf of the United States government and the people of the United States that we want to help build that trust and we want to offer constructive solutions, and please call on us to do that," Barton said.

With the challenges known and a strong team in place to overcome them, Barton suggests that the world take inspiration from the successful effort to eliminate smallpox around the globe. After 13 years of vaccinating people against smallpox, it took five more years to remove that virus from just three remaining countries; by 1980, the international community had reached its goal.

Replicating that success with polio would not only give hope and opportunity to children everywhere, but would also be "a beacon of hope for other development goals," said panelist Jim Lacy, chair of Rotary International's Polio Eradication Advocacy Task Force for the United States. Already, polio immunization campaigns have allowed for administering measles vaccines and distributing vitamins and mosquito nets, according to a September report by the Living Proof Project, a Gates Foundation initiative.

Panel moderator Dr. William Foege, senior fellow of the global health program at the Gates Foundation and a former CDC director, expressed the importance of carrying out the polio eradication initiative to its completion.

"The future will look back and won't thank us at all for starting the polio eradication program," he said. "But they will look back and thank us for ending the polio eradication program."