Time to end polio

The polio disease was a major concern in Australia in the 50s, but as a health care policy concern, it is now experiencing a resurgence of focus due to the efforts of scientists and public health advocates to rid the globe of the disease.

More than 450 scientists from over 80 countries including several from the University of Melbourne have signed the Scientific Declaration on Polio Eradication, launched in April. 

Polio, which is highly infectious, is spread by poor hygiene and causes paralysis and death mostly in children. It is still endemic in Nigeria, Pakistan and Afghanistan. 

University of Melbourne signatories include Sir Gustav Nossal, Nobel Laureate Peter Doherty, and international population health experts Terry Nolan, Julie Bines and Tilman Ruff.

Associate Professor Ruff from the Nossal Institute for Global Health and adviser to the Australian Red Cross and World Health Organization, says polio is a highly mobile infection and easily transmitted from human to human if vaccination is low or non-existent. 

Although the last case in Australia was in 2007 and despite immunisation against polio being included in the combination vaccines recommended and funded for all babies, he says we are not immune as the disease can be easily spread by plane travel and brought back into the country.

“The potential for the disease spreading in Australia is lower than in many other countries but we are still vulnerable to importation of the disease. Travellers can bring the virus back and transmit it to others even if they don’t become ill themselves.

“People travelling to these endemic countries should definitely have a booster polio vaccine. Often this is best given in a combination with boosters against diphtheria, tetanus and whooping cough, without an extra injection.”

Importation of the disease globally can occur via any travellers – migrant workers, pilgrims, business or holiday travellers, or those visiting friends and relatives.  The last case diagnosed in Australia was a student returning from visiting his home in Pakistan.

“For every one person who gets paralysis, 300 get the infection, without knowing about it. Paralysis from polio is usually permanent. So this is a very serious infectious disease we are dealing with,” he says.

Health experts have come together on the Declaration to endorse a new strategy by the Global Polio Eradication Initiative (GPEI) to reach and sustain global eradication by 2018. 

“Much like smallpox has been eradicated – we can achieve this for polio as well. This new global strategy is the plan we have to eradicate polio for good across the globe,” he says.

Some of the goals of the group are sustained government funding, increased routine immunisation, strengthening security measures for immunisation staff in politically unstable nations, and deepening ties with community and religious leaders.

Experts believe the time is optimal to eradicate the disease.

There are fewer cases now than ever before. From an estimated 350,000 cases of wild polio virus disease in more than 125 countries in 1988, there were fewer than 250 cases globally in just five countries in 2012, with India in particular having its last case 15 months ago.

The remaining endemic countries Nigeria, Afghanistan and Pakistan have in recent years launched key health campaigns to address the spread of the disease that have resulted in significant improvements in immunisation programs and the recording of the fewest new cases on record.

Two effective vaccines have also protected hundreds of millions of children against the disease: oral polio vaccine and the inactivated polio vaccine delivered by injection. 

Advantages of the oral vaccine, which is a live virus, are that it is cheap, easily given, and has the advantage of spreading in households, so that more than one person is protected for every person immunised. But unfortunately it sometimes itself causes paralysis. More effective and safer oral vaccines which target one or two rather than all three of the poliovirus types have been developed.

Richer countries like Australia are able to have safer methods of delivering polio vaccinations – the injectable vaccine cannot cause paralysis.

“The new plan clearly articulates how we can phase out oral vaccines and go towards adopting less risky options across the globe and in the countries that most need it.”

Experts are calling on endemic country governments to strengthen security measures and deepen engagement with community and religious leaders to overcome deliberately spread false rumours regarding the vaccine and promote uptake in their communities. 

They also need to protect vaccination teams and volunteers, particularly in light of attacks on health workers across Pakistan and Nigeria.

“It is such a pity that in some cases false and politically motivated rumours have been spread, such as polio vaccination being a western plot to sterilise Muslim women,” Professor Ruff says. “This plan aims to more effectively address this issue.”

A strengthening of global links across all polio vaccination efforts is also sought, helping other routine immunisations and other health initiatives, including measles prevention and maternal and child health and nutrition.

Funding for the eradication of polio has been consistent globally but needs to rise for the strategic plan to be successful. 

Over the past 30 years Australia has contributed around $65million to the eradication of polio, with funding plateauing in the last few years.

Professor Ruff says there is no doubt that if our eradication efforts fail, we will have hundreds of thousands of children paralysed with polio every year again around the world. 

“If we cannot eradicate polio now it will again find susceptible people and groups in poorer countries.

“Every child and every new generation needs to be protected from the outbreak of disease. 

“Ultimately if we don’t have to give vaccinations – then we will have won and we will definitely recoup the money invested in these programs many times over,” he says

ni.unimelb.edu.au

www.polioeradication.org/