Double vaccines ‘could hasten the end of polio’

This is an interesting piece on the current global fight against Polio, written by James Gallagher Health editor, BBC News website.

Using both types of polio vaccine could speed up efforts to free the world of the disease, research suggests.
The oral vaccine is leading the fight to eradicate polio, but trials in India show an additional injection of inactivated virus boosts immunity.
The World Health Organization said the findings, published in the journal Science, were “truly historic”.
The disease, which is spread through contaminated faeces, can cause paralysis and even death.
Fighting polio has been one of the biggest success stories in global health.
In 1988, there were 350,000 cases of polio in more than 125 countries.
The disease is now widespread in just three countries – Nigeria, Afghanistan and Pakistan – and cases have fallen by more than 99%.

Vaccines
Two drops of the oral vaccine, which contains a weakened polio virus, is the preferred tool in eradication efforts because it is cheap and gives resistance in the digestive tract to lower transmission of the virus.
The injected vaccine works largely in the bloodstream.
“But the oral vaccine is less effective in exactly those places we’d like it to work,” one of the researchers, Prof Nicholas Grassly, of Imperial College London, told the BBC.
It is thought other infections may interfere with the vaccine.
The solution has been multiple vaccination. As part of India’s successful eradication campaign, some children received 30 doses by the age of five.
Trials in India showed using an injection of inactivated virus as a booster jab was more effective than multiple drops.
However, the biggest challenge in banishing the disease for good is not the choice of vaccine, but getting to children in conflict-ridden areas.
The security issues can be huge and vaccination programmes are even used as a political weapon.
In 2012, the Taliban said vaccinations in the North and South Waziristan regions of Pakistan were banned until the US ended drone strikes.
Prof Grassly argues: “If you have limited access, you want the biggest return. If you can go in with inactivated and oral polio vaccine, you will achieve a lot more than if you just have brief access with oral polio vaccine.”
The double-vaccine approach is already being used in parts of Nigeria and will soon be introduced into Pakistan also.
Dr Bruce Aylward, the World Health Organization assistant director general for polio, said: “The results of this study are truly historic in the context of global polio eradication.
“This study has revolutionised our understanding of inactivated polio vaccine and how to use it in the global eradication effort to ensure children receive the best and quickest protection possible from this disease.”

WHO, Islamic Leaders Summit To Stop Polio Worker Attacks

Courtesy Of Channel Television:
Top World Health Organisation officials and Islamic leaders will meet in Egypt next week in an effort to stop attacks on polio workers, which are hampering the eradication of the virus in some countries with large Muslim populations.
“Shooting health workers who are protecting kids from this crippling disease is against the Koran and everything Islam stands for,” WHO’s Assistant Director-General Bruce Aylward told Reuters in Canberra said on Friday.

Gunmen in Pakistan and Nigeria have killed more than 20 health workers in the past three months in a series of attacks linked to a backlash against the immunization program against the crippling virus.

“Muslim leaders have been great advocates of immunization and generally the support has always been there. In Cairo, we are meeting senior Islamic leaders to get a sense of what we can do, and ask them how can you help us,” said Aylward.

The WHO has successfully eliminated polio from most nations after a 25-year campaign, but the crippling condition remains endemic in three nations, Afghanistan, Pakistan and Nigeria, where some influential Muslim leaders have opposed the program as a conspiracy of western medicine.

WHO remains on target to eradicate polio globally by 2018, Aylward said, despite a violent backlash from militant groups in Pakistan and Nigeria.

But there are also worrying signs of persistence, with the polio virus found in sewers in Cairo in January, with the type linked to the indigenous strain in Pakistan. Egypt has not had a case of polio since 2004.

Aylward said while the violence has forced the WHO to revise is approach to immunizations in both Pakistan and Nigeria.

“The goal is to put tools in the hands of the communities to immunize their own kids,” Aylward said.

“The overall risks (of contracting polio) are getting smaller, because we are finally getting into some of these difficult places,” he said.

Since 1988, the WHO has cut the number of global polio cases from 350,000 to just 225 in 2012, with India declared polio free in January 2012.

Polio Eradication: “a Global Public Health Emergency”!

The 65th WHA has declared Polio eradication a “Global Public Health Emergency” the statement is weighty, Here’s a quick summary of the implications of the World Health Assembly’s Resolution:
1.) Polio eradication has reached a tipping point. While the world is more than 99% of the way towards eradicating the disease, a funding shortfall has already caused vaccination activities to have been cut back – putting vulnerable communities at risk from the disease.
2.) If we fail to eradicate polio, the consequences will be disastrous. Research has shown that the world would soon see more than 200,000 cases a year. This is why the continued transmission of polio is now an emergency.
3.) This resolution gives countries greater powers to combat polio. For instance, they can choose to require travellers to and from polio-infected countries to be vaccinated against polio. Polio-infected countries have been urged to draw up emergency action plans for combating the virus.
4.) The resolution also calls for the World Health Organization’s 194 Member States to fully fund the Global Polio Eradication Initiative.
Declaring polio an emergency for global public health is an important step forward, yet we will only see the end of polio if the funding gap is filled. This is why we are asking world leaders to go beyond words and ensure that the Global Polio Eradication Initiative is fully funded.
We are about the end of the Q2 2012, the number WPVs are 30 already, Unless our politicians and other leadership are serious, only then perhaps, the target of 2012 is already a mirage.

The End of Polio: Polio’s last percentage – Bill and Melinda Gate’s Foundation

I came across this on the internet and as an agent of social change, fighting inequity across the globe, I felt duty bound to spread the message. It reads as follows:
Polio – a disease which has disabled millions and pulled people further into poverty – has been reduced by 99% over the past 25 years.
Global efforts have delivered incredible progress: immunising more than 2 billion children and saving more than 8 million children from life-long paralysis or death. In January, the world reached a remarkable milestone in the fight to eradicate polio – 12 months without a case of polio in India for the first time in history.
But progress towards eradication is at risk: with the critical work of the Global Polio Eradication Initiative constrained by a funding gap of almost US$1 billion for 2012/13 – threatening international polio eradication efforts.
That’s why the Global Poverty Project is working with partners to support the Global Polio Eradication Initiative, and make the end of polio reality.

We can all play a role in ensuring that polio is eradicated.

Last year, more than 20,000 ordinary people made their voices heard and helped convince five world leaders, together with Bill Gates, to announce an additional $118 million in funding for the Global Polio Eradication Initiative. This year, we’re calling on delegates to the United Nations General Assembly to announce further funding for polio eradication, closing the funding gap that’s currently leaving millions of children vulnerable to polio.

Global PEI under threat: A Ban on Polio Vaccination in Parts of Pakistan Puts the Entire World at Risk

I came a cross a colleagues link on this from TIME magazine and decided to share the story:
Thousands of public-health workers fan out across Pakistan today in the first day of a three-day campaign to vaccinate the country’s children against polio, an estimated 250,000 won’t be receiving the potentially lifesaving dose, the social-affairs secretary for Pakistan’s Federally Administered Tribal Areas, Aftab Akbar Durrani, told VOA’s Urdu Service yesterday. Last month, militant leaders in two of the most lawless districts of Pakistan’s Federally Administered Tribal Areas (FATA) declared that the vaccination teams would not be allowed to conduct their campaign, declaring that the locally run program was merely a ruse to allow American spies to penetrate the region. “In the garb of these vaccination campaigns, the U.S. and its allies are running their spying networks in FATA, which has brought death and destruction on them in the form of drone strikes,” wrote Mullah Nazir, one of South Waziristan’s major militant commanders, in a pamphlet that was widely distributed on June 25. His screed echoed that of a commander in North Waziristan, Hafiz Gul Bahadur, whose own pamphlet from a week earlier was even more direct: “We don’t want benefits from well-wishers who spend billions to save children from polio, which can affect one or two out of hundreds of thousands, while on the other hand the same well-wisher (America) with the help of its slave (Pakistan’s government) kills hundreds of innocent tribesmen including old women and children by unleashing numerous drone attacks.” The ban on vaccinations, he continued, would not be lifted until the drone strikes stop.

Both Nazir and Bahadur reiterated to TIME through a special correspondent in Peshawar yesterday that they would not reconsider the ban on vaccination teams, citing the ongoing drone campaign in the country’s tribal regions.

(MORE: The Taliban Halts Polio Vaccines — and Pakistan’s Kids Will Pay)

As my colleague Jeffrey Kluger wrote in the wake of the first pamphlet,

Using children as medical poker chips is indefensible under any circumstances, but the Pakistanis do have other reasons to be suspicious of Westerners bearing vaccines. In the months leading up to [Osama] bin Laden’s killing in May 2011, a local doctor who was also working for the CIA ran a hepatitis-vaccination campaign in and around Abbottabad, where bin Laden was holed up. The real purpose was to try to obtain DNA samples that would confirm bin Laden or his family members were indeed in residence. That, surely, figured in the Taliban’s decision.

But the militant’s math — “one or two out of hundreds of thousands” — demonstrates an egregious misunderstanding of the sinister swath that polio can cut through a population of healthy, active kids, according to Kluger:

For every clinical case of polio, there are 200 subclinical ones that can present themselves merely as a bad summer cold; but that’s 200 active carriers who can and do spread the wild virus. Even people who are infected with what will turn out to be a crippling strain of the disease do not know they’re sick for a week or more, as the virus makes the long journey from the throat to the gut to the bloodstream — multiplying explosively all the way — and finally to the anterior horns of the spinal cord and the medulla oblongata of the brain, where it wipes out the cells that signal the muscles, paralyzing them forever.

(MORE: Polio’s Back. Why Now?)

The vaccination campaigns take place every six weeks or so; each child under the age of 5 requires three doses to ensure that he or she is truly immune. So not only will the militants’ ban leave the very young vulnerable, it will also negate the effects of previous vaccination campaigns. That too will have long-term consequences, not just for the children but for the worldwide campaign to eradicate polio for good, according to Kluger:

Until very recently, polio appeared to be at the very brink of eradication — which would make it only the second disease ever to be wiped out in the wild, following smallpox, which was finally vaccinated out of existence in 1977. As recently as 1988, there were 350,000 cases of polio worldwide, distributed across 125 countries. Thanks to an aggressive, 24-year eradication campaign headed by UNICEF, WHO, the CDC and Rotary International, however, there were only 650 cases worldwide last year and only 73 so far this year — confined to just three countries: Afghanistan, Pakistan and Nigeria.

Afghanistan’s 10 cases this year have occurred in the country’s south, along the border with Pakistan, where ongoing fighting has prevented vaccination teams from accessing the children. Pakistan’s 22 cases, however, have occurred in all four of the country’s provinces, a worrying sign of the disease’s spread. Nigeria, with 52 cases of paralysis this year, will still be the most difficult country to tackle, though numbers have plummeted over the past four years. (There have been 11 new cases in Nigeria in the three weeks since Kluger wrote his story, which explains the discrepancy.)

Still, with so few cases worldwide, the prospect of global eradication is tantalizingly close. The longer the Pakistani militants’ ban on vaccination goes on, the more difficult it will be to reach that goal. They might think they are making a point, instead they are holding the lives of Pakistan’s, and the world’s, children hostage. When challenged on that point, both Nazir and Bahadur argued that they were looking out for the long-term good of their people. It’s hard to see how.

MORE: Bill Gates: ‘We’re Making Progress’ at Eradicating Polio

Why polio just became a global health crisis!

Another interesting piece on Polio Eradication to share.

Though only 650 cases were recorded last year, the World Health Organization declared the disease an emergency, but its importance goes beyond public health.

Few people probably associate the phrase “global health emergency” with polio, a disease that has been around for 5000 years and is on a decades-long decline so steep that there are less than a thousand recorded cases left on Earth, and it no longer even seems real to many in the developed world. “Global health emergency” might sound applicable to HIV/AIDS, malaria, or cancer, but polio?

And yet, that is exactly what happened late last Friday afternoon in Geneva, when the World Health Assembly, the governing body of the World Health Organization, declared polio a public health emergency, calling for the 194 member states to fully fund the Global Polio Eradication Initiative, and fill the currently $945 million gap in its budget for 2012-13. But this is about much more than just filling a budget shortfall: polio’s threat is still very real, and the mission to finally stamp it out forever is a crucial one for reasons even bigger than the disease itself.

Since the world decided to come together to eradicate polio in 1988, the disease has been almost entirely eliminated. It killed or paralysed more than 350,000 children each year in the 1980s, but there were just 650 recorded cases in 2011. In January, India celebrated its first polio-free year in history, leaving the disease endemic in just three countries: Nigeria, Pakistan and Afghanistan. The latest figures from the World Health Organization show only 60 cases so far in 2012.

But polio is a different type of emergency than the ones we usually hear about in the news. Its biggest danger isn’t the current number of cases, but the implications for failure: not only because a failure to eradicate could allow for a resurgence that could kill or disable thousands of children each year, but because of what it holds for the effectiveness of our global health systems itself.

Part of the risk has to do with money. Over the past quarter century, $9.5 billion has already been spent on polio eradication, driven by international organizations — primarily the WHO and UNICEF — as well as private donors such as the Gates Foundation and Rotary. The WHO’s strategic advisory group of experts on immunization have said that failure to eradicate polio would be “the most expensive public health failure in history.” A failure to make all that money achieve its intended goal could make it tougher to solicit donations from countries and individuals for future eradication campaigns.

The other element is symbolic. In a sense, polio will be a marker of either what the world can or cannot achieve in global health. “If we finish polio eradication, what it will prove is that with a relatively modest investment in the grand scheme of things, you can achieve real health outcomes,” says Bruce Aylward, the Canadian epidemiologist who heads the WHO’s eradication efforts.

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Losing Polio!

I came across this very interesting piece from US Foreign Policy site (by Laurie Garrett) titled: Losing Polio.
“As cries of concern from New Delhi grew louder, earlier this year the WHO gave Islamabad a stern warning: Stop polio or face global health travel restrictions, which would be economically crippling. After two years of mishaps in its bungled immunization efforts, Pakistan’s health leadership went overboard, stopping cars at tollbooths and dropping polio vaccine into every child passenger’s mouth. By April, local polio trackers sent numbers to Geneva that the WHO interpreted as hopeful signs that the disease was finally coming under control. But recently, Pakistan’s chief health commissioner Tariq Pirzada revealed that the numbers were faked by overzealous officials eager to please the WHO. In truth, rural immunization rates remain appalling.

The call for polio eradication goes back decades, and was initially backed by millions of members of the Rotary Club International, which raised much of the money used to eliminate the disease from the Americas, nearly all of Africa, and Southeast Asia. More recently, philanthropist Bill Gates jumped into the fray, donating billions of dollars to the effort. Combined with the WHO, UNICEF, and other organizations, these players eliminated 99 percent of the global burden of the disease, including cases of permanent paralysis caused by the crippling virus and deaths. But in mid-May, U.N. Secretary-General Ban Ki-Moon warned that the great achievements to date could collapse if polio efforts fail in Afghanistan, Nigeria, and Pakistan. 

“There is a looming danger that we could fall victim to our own success,” he warned. “Here’s why: The world is now populated by a generation that for the most part has never been exposed to polio. Additionally, many in this generation have been inadequately vaccinated. When the virus strikes under those conditions, the impact can be devastating. We saw that in the Republic of Congo and elsewhere in Africa in 2010, when an outbreak killed half of all who contracted the virus.”

Eradication is tenuous. Since the early 1960s it has been known that the polio virus can be carried by higher primate species, including monkeys, chimpanzees, and gorillas. In the laboratory it is also possible to infect rodent and chicken cells with the virus, though there is no evidence of those species carrying polio in nature. Nevertheless,  unlike smallpox — the only human pathogen ever eradicated — polio isn’t merely a Homo sapiens germ.

The virus, moreover, enters the human body in multiple ways, and after vaccination may continue to reside in the gastrointestinal (GI) tracts of infected individuals. Back in the 1950s, when scientists Jonas Salk and Albert Sabin competed to be the first to invent a vaccine, Salk created an injectable version that eliminated the virus from the individual’s bloodstream, built up antibodies, and completely protected children from the disease. But Sabin showed that those children could still harbor viruses (harmlessly to themselves) in their GI tracts, and shed infectious microbes in their faeces. Thus, Sabin said, oral vaccination was preferable, as it cleansed the intestines and built up local cellular immunity that protected not only the vaccinated individual, but the general public health by eliminating faecal passage of virus into water supplies, food, and untreated sewage systems.

Broadly speaking, this conflict between oral versus injected vaccination, public versus individual protection, and lifelong immunity versus temporary was at the heart of ongoing technical disputes regarding how best to target the disease, and whether eradication is even possible. While oral vaccination is easier than giving shots, its immunization impact is weaker and wanes with time — even fairly recently immunized Indian children are showing signs of lost protection. Overcoming this requires giving a child as many as seven doses of polio vaccine droplets over a period of months — a monumental logistics feat for poor countries, particularly in rural areas.

After years of struggle, India succeeded in vanquishing polio only when it switched its vaccine strategy to radically decrease the need for boosters. Instead of using an oral formulation that counters all three strains of polio viruses at the same time — but weakly — in 2009, India introduced a stronger vaccine that targets only the dominant two polio strains. The new vaccine gave children a 30 percent more powerful initial immune response, meaning that even without boosters, many Indian kids were protected. The impact was immediately felt, even in the poorest parts of the country. But this strategy may have rendered the children only temporarily protected, accounting for India’s fears of Pakistani vaccination failure. Yet the government should also be concerned about its own population’s anti-vaccine movement, which has reached middle-class India, where some parents decline immunization under false grounds that it would contribute to autism.

The world is very close to victory, but the remaining challenges are more cultural and political than scientific. Last year, a team of experts was deployed by the U.S. Agency for International Development to Afghanistan, Nigeria, and Pakistan to ask  local villagers what the polio eradication effort was doing wrong. In village after village, they got the same astonishingly obvious answer: Stop sending teams of men to vaccinate our children. Even a rudimentary understanding of conservative Muslim culture should have taught the would-be disease vanquishers that under Islam a woman may not allow an unrelated male into her home without her husband’s presence, nor should she allow the well-meaning gentleman to touch her female children. In all too many cases, vaccine failure boiled down to finally sending all-female health teams to Muslim-dominated villages.

Though the WHO says the final eradication effort is shy $1 billion, money is less likely to decide the fate of the great polio elimination campaign than governance, politics, and culture in three hotbed nations. Which is why the CIA’s use of a phony vaccine campaign is so infuriating to health officials. It undermined the faith that many Muslims in vulnerable countries place in Western-inspired immunization and medicine. And with millions of children in India and some other countries now experiencing waning immunity, time is decidedly against us. If wild polio hasn’t been eliminated from the final three countries by the end of 2012, the virus could well resurge in sites of alleged eradication, all over the world. And thousands will suffer.”

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