What Does a World Without Polio Look Like?
Americans have forgotten our fear of polio. We think of it as a disease of our parents’ generation; a bygone threat. America has not seen a case of wild poliovirus since 1979. In fact, around the world, polio cases have decreased by more than 99 percent since 1988, from an estimated 350,000 cases then, to 359 reported cases in 2014. Polio is now only endemic in two countries: Pakistan and Afghanistan.
But it’s not time to pack up and go home yet. Like most public health achievements, this one is tenuous. Unless the global community can extend vaccination to every child and fully eradicate wild polio, the threat of another outbreak of polio — which causes paralysis in one out of 200 infections and kills 5 to 10 percent of those it paralyzes — will continue to loom large.
The next few months present an important opportunity. January through April is the low transmission season for polio. With few remaining cases and the upcoming period of low transmission, we have an opportunity to eradicate polio once and for all. If we can capitalize on this window, a world without polio is just around the corner.
But what’s next? Decades of polio eradication initiatives have established a global workforce of thousands who have built their careers around the goal of a polio-free world. As we consider how to move forward after polio, we must not let their experience go to waste.
Many of these professionals will still be needed in the polio effort. To prevent a resurgence of polio, even countries that are certified polio-free will need to maintain disease surveillance, containment and outbreak preparedness as ongoing public health functions. The polio eradication infrastructure has also bolstered immunization for other diseases. Countries will need to plan carefully to prevent immunization coverage from backsliding as they scale back polio eradication programs.
Each country’s strategy will be different, but wherever possible, people whose skills are no longer needed to combat polio should apply their experience to other health interventions. Other disease programs could benefit greatly from the expertise of those on the front lines of the war against polio. Several countries are already putting this into action. For example, in India, the network of health workers and resources used to combat polio is now being used to fight measles and rubella, and communications strategies that were successful in the polio program are now being used to encourage parents to vaccinate their children.
Along with human resources, countries and organizations will also need to consider how to redirect financial resources. This presents an opportunity for other programs, such as routine immunization, to advocate for greater funding.
Withdrawing polio infrastructure and assets without damaging health systems or immunization rates will require a well-coordinated transition plan. Now is the time, in the last mile of the fight against this deadly disease, to start a global conversation about the polio legacy, and chart the course ahead.
We hope a dialogue about how to reallocate resources from polio efforts will continue among African leaders at the Ministerial Conference on Immunization in Africa, which will be held in Addis Ababa, Ethiopia, from February 24-25, 2015.