In January 2014 it was reported that India had become polio free, marking three years since its last reported case. This is a major success not only for India but also for global eradication efforts. The World Health Organisation (WHO) launched the Global Polio Eradication Initiative (GPEI) in 1988, when the poliovirus was endemic in 125 countries and when approximately 350,000 people were paralysed each year due to the disease. The Gates Foundation has been a key player in supporting the WHO initiative and in pushing forward global eradication efforts. Since GPEI began, it has saved about 10 million children from paralysis, and now there are only three countries where polio remains endemic: Nigeria, Pakistan and Afghanistan. The success of GPEI is evident in these numbers, and the route to this success is interesting in relation to other global development efforts. But in the three remaining endemic countries, there is a political and social battle being fought through polio eradication efforts: Vaccination workers are being attacked by Islamic militants who oppose the Westernisation of their countries.
Polio is an infectious, crippling and potentially fatal disease. There is no cure, but there are effective vaccines. Polio can occur at any age, but it is most prevalent in children under five. The disease is spread from person to person contact, and it first enters the body through the mouth but is spread through faeces. Accordingly, in communities with poor hygiene and unsatisfactory sanitation infrastructure, it can spread rapidly. One of the most difficult features of polio is that people infected with the poliovirus often experience no symptoms or signs of illness, so they carry the virus and infect many others; only after a considerable amount of time does polio become recognisable. This is why when one case of polio is identified in a region, the WHO considers it to be an epidemic. In 1952, Dr. Jonas Salk developed the first effective vaccine against polio, and in 1961 Albert Sabin further improved upon this by introducing an oral polio vaccine.
With the Millennium Development Goals due to expire in 2015, there is widespread debate about what the next phase of global development action should include and how these aims will be achieved. A movement has started in the World Health Assembly, which represents WHO members, to focus more global development efforts on extending immunisation programmes. This has become known as the decade of vaccines, which aims to achieve a ‘world free from vaccine-preventable diseases, with the full benefits of immunization reaching all people, regardless of who they are or where they live’. This movement relies heavily on the success of the polio eradication programme, showing how this programme is influencing future global initiatives.
Despite these positive developments relating to polio, there remain issues of concern—especially in Pakistan, where polio eradication efforts are being halted by attacks on vaccination workers and through the spreading of anti-vaccination propaganda. In January, suspected Taliban militants killed three medical workers who were administering polio vaccinations in Karachi. In addition, the city of Peshawar is ‘under assault by the Taliban,’ according to the Financial Times. The WHO announced last month that Peshawar is the ‘largest reservoir of endemic poliovirus in the world.’ The situation in Peshawar poses many challenges to eradicating polio not only because the region is still at great risk, with Afghanistan still considered endemic, but also due to the political tensions that vaccination schemes are being met with that are challenging the traditional—and effective—methods of combating the disease. It is important both that polio eradication efforts are accompanied by education and that local knowledge and norms are used to integrate the schemes into everyday life.
When considering this area within the wider context of sustainable development and of reducing global inequalities, a questions remains: Are there lessons to be learnt from the polio eradication effort? Although the eradication of one identified disease is comparably easier than other important global development challenges, it would be a mistake not to identify the positive lessons from this process. For example, in India local religious and community leaders were the key both to developing local support for vaccination centres and for persuading parents to vaccinate their children. The three elements of the plan outlined in the Polio Eradication and Endgame Strategic Plan 2013-2018 are fundamental to any development initiative. These elements are; one size does not fit all, technological innovation cannot overcome gaps in programme management and community engagement, and a combination of innovations tailored to the country context can deliver success in even the most challenging conditions. This focus on bottom-up leadership needs to be adopted within the post-2015 development strategy, by identifying local issues, initiating relevant solutions and integrating these positive changes into the cultural and social norms of the country or region, real sustainable progress can be achieved.
KATE O DONNELL