DISTRICT 9350

THE ROTARY FOUNDATION

POLIO PLUS

  Letter from PDG Rodney Mazinter - THE FACTS

I received a letter the other day suggesting that Rotary's fixation with polio is misguided and that there are far more urgent, and therefore more important, health priorities in Africa that should be occupying our attention. My correspondent then went on to cite AIDS, malaria and TB amongst others.

All the world is concerned, particularly in Africa, with the terrible threat of AIDS, and it is understandable that there are those with different opinions about priorities in the deployment of health resources. But the case for polio is sound, because it is something for which we do have a vaccine, a workable strategy, and have shown tremendous progress. The evidence that the strategy is working is irrefutable. Polio already has been eradicated in nations with the same kinds of problems that exist in the 20 remaining polio endemic countries.

Most significantly, a little appreciated and less publicised truth, It is an effort that is producing great benefits in the battle against other infectious diseases.

There are many men and women today who were not in Rotary when PolioPlus started. As Rotarians we have every justification to be proud at what has been achieved to date. Let us look for a moment at the facts about polio eradication in Africa and further afield, and at Rotary's and its partners' role in the campaign.

By 2005 Rotary clubs worldwide will have contributed US$ 500 million to a campaign that will eventually cost US$1.5 billion. The Rotary Foundation of Rotary International has contributed more than US$9.5 million in PolioPlus funds to the following Central and Southern African countries:

An additional $2.7 million funding has been provided by Rotary clubs in non- endemic countries for help to Rotary clubs waging the campaign in polio endemic countries.

Rotary International is the volunteer arm of a global four pronged partnership dedicated to eradicating polio. Public partners include the World Health Organisation (WHO), UNICEF and the US Centres for Disease Control and Prevention.

The campaign began in 1985 when Rotary volunteers around the world embraced the fight against polio by raising over US$247 million and creating the programme called PolioPlus. The name PolioPlus emphasises that the aim is not merely to eradicate the disease but also to deliver supplementary health services such as vitamin A and the establishment of viable clinics and laboratories for surveillance and further immunisation purposes.

The PolioPlus programme is the most ambitious programme in Rotary's history. The initiative is an aggressive public/private partnership to assist international health agencies and governments in eradicating polio and certifying the world polio-free by 2005, Rotary's centennial.

To date, the PolioPlus programme of Rotary has contributed US$340 million to the protection of more than one billion children. More to the point, Rotary volunteers offer their compassion, time and expertise. With its community based network worldwide, Rotarians assist in vaccine delivery, social mobilisation and logistical help in co-operation with the national health ministries. I was personally involved in the National Immunisation days in South Africa in July 1996 and in Ethiopia in 1997.

Today, billions of children have been protected against polio. Because of the polio eradication initiative of the last decade approximately three million children who might have been polio victims are walking and playing normally. The Western Hemisphere was declared free from polio in 1994. Most of Europe, China and the Western Pacific are free from the disease. Endemic on five continents in 1988, polio today is confined to children in sub-Saharan Africa and South Asia. This would not have been possible if it were not for the use of the oral vaccine. There is a tiny risk in using the live polio virus to vaccinate. Statistics reveal that the incidence of paralysis after the first administration is one in six million; after the second administration it is one in 100 million.

Given the benefits, the risk is worth taking. Only a few first world, industrialised countries, can afford to consider this risk unacceptable and insist on the far more expensive and difficult to administer injection (IPV). It is worth remembering that once the world is declared polio-free (only the second disease in history after smallpox to be totally eradicated) there will be a US$1.5 billion saving each and every year in routine immunisation costs. (The saving resulting from no longer having to give routine smallpox immunisation is US$1 billion every year.)

The strategy recommended by WHO, and followed implicitly for the past sixteen years, has brought the disease to the verge of eradication. This has been:

The five-day effort began with an official launch in Kinshasa, the capital of the Democratic Republic of Congo, hosted by the country's head of state President Joseph Kabila. Senior government representatives from Angola, Congo-Brazzaville and Gabon, as well as World Health Organisation Director-General Gro Harlem Brundtland, WHO Regional Director for Africa Ebrahim Samba, UNICEF Regional Director for West and Central Africa Rima Salah, and Past Rotary International President Carlo Ravizza attended the ceremony.

By simultaneously targeting the population at risk in one of the last reservoirs of polio, the campaigners hoped to cut the viral transmission chain and finally eradicate the crippling disease. Last year, the region accounted for about 40 percent of cases of polio reported in Africa, underscoring the importance of this campaign. The campaign's estimated cost of US$44 million was funded by contributions from the four nations involved and foreign donors led by Rotary International and its partners in the Global Polio Eradication Initiative.

Vaccinators aimed at improving their coverage by going "door to door" instead of waiting for parents to bring their children to a vaccination site. "We shall also vaccinate children in the street, the market places, work places and wherever we find them," said Dr Jean Claude Mubalama, who co-ordinated the effort in the Democratic Republic of Congo, which presented the biggest logistical challenge.

Days of tranquillity, negotiated by the United Nations, allowed health workers and volunteers to reach children in war affected areas of Angola and the Democratic Republic of Congo. Follow-up joint NIDs are planned on 6-13 August and 13-17 September in the four countries that participated in the five-day immunisation activities.

The number of polio cases worldwide has decreased 99 percent since 1988. In that year 350,000 cases were reported; fewer than 3,500 cases were reported in 2000 - down by 50% over the previous 12 months. The reduction is credited to the World Health assembly's call in 1999 to accelerate vaccination efforts, including increased rounds of National Immunisation Days (NIDs). The Assembly also urged vaccination teams to go house-to-house to find and immunise more children.

Last year, a record 550 million children under five years of age were immunised in 82 countries. This included India, where 152 million children were vaccinated in three days, and a synchronised effort across West and Central Africa, which immunised 76 million children in 17 countries. The polio virus now exists in no more than 20 countries, down from 30 in 1999 and 125 in 1988.

In South Africa there is a far more sophisticated health delivery system in place than the rest of Africa combined. Routine immunisation is well established and for the more rural areas NIDs, such as those that took place this year in Natal, provide cover. Surveillance is also good and every case of acute flaccid paralysis is examined to determine if it was caused by the polio virus. You can rest assured that the international campaign to eradicate this disease is well on course. There is still a US$400 million funding shortfall to be found in order to achieve the goal of declaring the world polio-free by the end of next year, but when one considers that this shortfall was US$500 million just a few short months ago, this must give rise to optimism.