Polio Eradication

Rotary’s Campaign to Eradicate Polio Worldwide

The problem

A polio-free India is a magnificent achievement, and it’s Rotary’s achievement,Bruce Aylward, World Health Organisation, Rotary International Convention, Bangkok, 6-9 May 2012. Click to see Video Presentation While only older people remember children in callipers with flaccid legs (‘infantile paralysis’) and adults in ‘iron lungs’, it is a depressing reality that unless polio is eradicated globally, a return of such horrors may be only a flight away!

Poliomyelitis is not hereditary. It results from poor hygiene and bad sanitation. Of the three strains, each needing a specific vaccine, P1 is the most lethal, but P3 is the most prevalent, while P2 was eradicated in 1999. The polio virus enters children’s bodies though contaminated food or water – the faeco-oral route – and multiplies in the throat or intestine. From there it passes into the blood stream or sometimes the nervous system, causing paralysis by destroying the nerve cells, which cannot regenerate. Over 99% of children have only a mild form of fever and body ache, which may go undetected as the polio virus infection; fewer than 1% of them develop acute flaccid paralysis.

Infected children excrete the virus in the faeces, which can infect unimmunised children. The motivation for Rotary’s polio campaign stemmed from the eradication of smallpox, which like polio was a viral disease for which vaccines already existed. Unlike smallpox, polio viruses can survive for long periods outside a human host, especially in sewage.

The solution

Improvements in health and the provision of sanitation and clean water would offer huge advances, but the strategy to eradicate polio was to carry out vaccination on a global scale.

In 1985, Rotary International, the world’s largest service organisation, announced a plan to eradicate polio by vaccinating every at-risk child under five, and has since contributed over £625 million ($1 billion) to implement this plan*. In 1988, the World Health Organisation, UNICEF and the US Centers for Disease Control and Prevention joined Rotary to launch the Global Polio Eradication Initiative.

In 2007 the Gates Foundation became a major supporter by donating £62.5 million ($100 million) directly to Rotary, and in 2009 donated a further £160 million ($255 million). Rotary agreed to raise £125 million ($200 million) in matching funds, a target achieved on 17 January 2012.*

In the United Kingdom babies are vaccinated at the ages of six weeks, 10 weeks and 15 weeks, followed by a booster at 18 months. In countries where diarrhoea is common because of waterborne infections, children need far more doses to achieve the same immunity. So the solution to the problem has necessitated an immense effort on an unprecedented scale.

The vaccination process is simple. One person squeezes two drops of the oral polio vaccine (OPV) from a plastic vial on to the tongue of a child and one uses an indelible pen to mark the child’s finger – a purple pinkie – to indicate they have been vaccinated. This takes only a few seconds and costs about 50p (80 cents).

As a result of this long-term strategy the number of polio cases has dropped by over 99% since 1988, from about 350,000 cases annually in 125 endemic countries to a very small number in 2012 in only three countries: Afghanistan, Nigeria, and Pakistan. On 13 January 2013 India marked two full calendar years without a single case, a staggering achievement in a developing country of over a billion people. But for India – or any other country – to be truly polio-free there must be no reported cases for a full three years. (* Conversion rate: US$1.6 = £1, October 2012)

The strategy

Routine immunisation is essential because it is the main way that polio-free countries protect their children from the threat of imported polio. The strategy is to administer four doses of polio vaccine to every child before their first birthday, then a dose on a specific day each year until their fifth birthday.

National Immunisation Days (NIDs) are set by governments as a critical eradication strategy. Rotary’s PolioPlus program has been one of the driving forces behind NIDs. To appreciate the scale of a typical NID, as many as 170 million children are immunised in a single day in India. The job of Rotarians and health workers is to dispense two drops of vaccine onto the tongues of as many children as they can find on that day.

Surveillance by health workers, assisted by Rotarians, plays an important role in finding, reporting, and investigating cases of acute flaccid paralysis, ideally within 48 hours of onset.

Targeted mop-up campaigns usually follow NIDs but are smaller operations, often requiring house-to-house visits to ensure than as few children as possible have missed being immunised.

What Rotary has done

Thank you, Rotary, Manmohan Singh, Prime Minister of India

Members of Rotary Clubs around the world have raised money in every conceivable way. District 1070 has “done its bit” by raising over £360,000 ($560,000) during a major campaign lasting 4½ years, which is about £130 ($200) per Rotarian and well in excess of the £3900 ($6,000) per club target originally set.

Rotarians have been involved before, during and after NIDs,
by providing funds for the vaccine, promoting immunisation,
particularly during ‘Rotary Week’, distributing vaccine to
health centres, serving as monitors, assisting health
workers and officials to reach every child, and
participating in general surveillance.

An interesting record of a typical NID in India and the experiences of the fifty Rotarians who took part in November 2010 has been produced by Jim Matthews (Rotary Club of Oadby, Leicester, England) at endpolionowindia.blogspot.com. All who took part were uplifted by the experience and were humbled by their tiny part in an immense 25-year programme whose imminent conclusion will be the global eradication of poliomyelitis.

What Rotary will do next

Completing polio eradication is now an emergency because the world fully understands the consequences of failure, Bruce Aylward, World Health
Organisation, Rotary International Convention, Bangkok, 6-9 May 2012 Photograph: A child (reluctantly) received ths polio vaccine orally.It is tempting to scale down the effort now that only small numbers of cases are reported in just three endemic countries. But there is no room for complacency: we cannot stop immunising until the world is polio-free.

Reaching children with the vaccine in the disease’s remaining strongholds requires funding and the effort to overcome challenges such as poor infrastructure, geographical isolation, armed conflict and cultural mistrust about the eradication campaign.

Whilst the focus is now on Afghanistan, Pakistan and Nigeria, India is still only just over the first hurdle and other countries are at risk with polio cases imported from the endemic countries. In Africa, Chad and the Congo have had significant outbreaks, and a few cases in China, which had been polio-free for a decade, were attributable to a virus from Pakistan.

Rotary is committed to support the following actions to achieve total polio eradication:
Halting the spread of the polio virus in the three remaining endemic countries, which continue to export it to polio-free areas:

  • Controlling polio outbreaks in previously polio-free countries;
  • Addressing low routine-immunisation rates and surveillance gaps in polio-free areas;
  • Maintaining funding and urging political commitment to implement the eradication strategies.

To emphasise Rotary’s continuing commitment to polio eradication, RIBI’s End Polio Now Committee has co-ordinated fundraising initiatives for World Polio Day on 24th October 2012 and for Rotary Day which takes place on 23rd February each year.

What you can do

“We can’t stop raising money until our entire world is certified as polio free,” John Germ, Chairman of Rotary’s US$200 Million Challenge Committee, Rotary International Assembly, San Diego, 15-21 January 2012.

During Rotary International’s 25-year campaign there has been a dramatic drop in the number of new polio cases and they are now at the lowest in history. But the task is not yet complete: Rotary still needs a great deal of money to ‘finish the job’ and this is where you can help. Remember: every £1 donated can save the lives of two at-risk children.

To donate to the Rotary Club’s End Polio Now campaign visit: www.rotary.org 

Please contact RFUK at www.rotarygbi.org to make a donation which includes Gift Aid.  Note: The text a donation has been removed as it was not cost effective.

The ‘Iron Lung’

Photograph: Children in Iron Lungs.

The Iron Lung was a reality of life for those with Polio until the 1950s/60s and is still in use in some places as the only means of keeping Polio sufferers alive.

Photograph: An Emerson Respirator - commonly known as an Iron Lung.Photograph: View of an Iron Lung.

Emmerson Respirators – ‘Iron Lungs’

Photograph: A young child in an Iron Lung.

A child could spend hours, days or weeks in an Iron Lung.

Photograph: A child with polio being wheeled through the streets of an African town.

 

In an age when we can put men on the Moon and send vehicles to explore Mars, children in third world countries are still suffering with Polio…

Photograph: A young boy with leg calipers sitting on a bench.

We ARE winning the battle to eradicate Polio. In the major endemic countries there is a 30% decline in cases reported year on year. Visit the End Polio Now pages for “Thanks for Life” day information. www.ribi.org/thanks-for-life)