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Polio eradication - the last push depends on politics, diplomacy and money

As a kid I can remember my Dad going off to Rotary meetings and coming back talking about how polio could one day be eradicated. He and his decidedly uncool and stuffy Rotarian buddies did some serious fund-raising for it in the town where I grew up. They have stuck at it since. I imagine they are now feeling incredibly proud of their efforts, as that great milestone may soon be achieved.

I also have met quite a few polio survivors professionally, a couple of whom are way younger than you might expect because they caught the disease overseas. I can only imagine how they are going to feel when their children, grandchildren and great-grandchildren are forever put beyond the reach of the virus which blighted their own lives.

A staggeringly important article passed almost unremarked yesterday in the Fairfax press. Norman Gillespie and Gustav Nossal wrote a short piece which summarises how close we are to finally eradicating polio. The stakes are high. If we allow polio to re-emerge it will, they say, “constitute the most expensive public health failure in history.” A motley amalgam of Rotarians, NGOs, scientists, bureaucrats, politicians and community leaders has brought the world to the brink of a stupendous public health achievement, only for it to be threatened with failure when their fingers are almost closing around the prize.

Since 1988, when there was 125 countries left with endemic polio, we are now down to 3. Two of those, Pakistan and Afghanistan, have suffered a combination of natural and military adversities which have derailed the public health efforts of authorities.

The other remaining endemic country is Nigeria. The story here is more complicated. Public health infrastructure is not superb, but it is at least as functional as its neighbours. The main problem in Nigeria is that there are communities where local religious leaders have bought into anti-vaccine conspiracy theories. The general facts are outlined here.

Purely religious objections to vaccinations as such are uncommon in most of the world, and the difficulty in Nigeria, and to a lesser extent in Pakistan and Afghanistan, seems to be due to an anti-Western ideological bias as well. Having said that, I would add that if mass vaccination programs are decided upon and planned by a central authority, such as WHO or UNICEF, they clearly need to be administered according to local sensitivities and culture. This was beautifully demonstrated in India (which passed 12 months without a new case of polio in January this year) where ambassadors such as Bhagwath Chandrasekhar and committed culturally-appropriate education programs have reversed the previous anti-vaccine propaganda. Perhaps the immunisation campaign has not been as effectively handled in Nigeria. Certainly the use of a vaccination program for intelligence purposes in Pakistan is a cynical ploy which might yet delay the success of polio eradication in the holdout areas.

Achieving a polio-free India is a monumental step to eradicating this appalling disease. Finishing it off is now just a matter of political will, skillful diplomacy and money.We cannot allow complacency, opportunism and scare-mongering to let it fail.

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