Striving for the global eradication of poliomyelitis.

When Ministers of health and representatives from the six remaining polio-endemic countries, namely Afghanistan, Egypt, India, the Niger, Nigeria and Pakistan, declared on 15 January 2004 at a high-level meeting in Geneva that poliomyelitis should be history within the following twelve months, they noted that the success of the initiative rests with the Governments of those countries. The Ministers had unveiled a bold new plan to immunize 250 million children multiple times during a series of massive polio immunization campaigns this year. As of September, with over 700 reported global cases for 2004, their goal, while close to being achieved, may not be met by 2005. The Global Polio Eradication Initiative of the World Health Organization sets 2008 as the target date.

Polio transmission levels are currently at their lowest ever in Egypt, India and Pakistan, providing their Governments with an unprecedented opportunity to stop transmission of the virus in 2004. Data from the six polio-endemic countries show that the virus has been reduced to only a few remaining reservoirs. The ministers concurred on an all-out effort to reach every child with the polio vaccine during the first half of 2004, particularly in India, Nigeria and Pakistan, which together account for more than 95 per cent of all polio cases worldwide. Within these countries, transmission of the disease is further confined to full "polio hotspots": the state of Kano in Nigeria, Uttar Pradesh and Bihar in India, and North West Frontier province and Sindh in Pakistan. They are linked to more than 75 per cent of all new cases worldwide.

As 2004 comes to a close, Nigeria is currently the greatest risk to global polio eradication. In late 2003, immunization against polio was discontinued in Kano, the last major polio reservoir in Africa, because of unfounded rumours that the vaccine was unsafe. As a result, the disease returned to Nigeria and has spread into the previously polio-free countries of Cameroon, Chad and through the Niger, into Benin, Burkina Faso, Ghana and Togo, endangering 15 million children and necessitating a massive immunization campaign across west and central Africa.

As of May 2004, Egypt, India, Pakistan and Afghanistan were on track to meet the year-end target for stopping polio. However, west and central Africa, particularly Nigeria and the Niger, suffered a significant setback due to an outbreak that originated in northern Nigeria, where immunization campaigns were suspended in August 2003.

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This required a new strategy that included the reintroduction of a mass, synchronized immunization campaign across 22 countries by early 2005 at the latest, aimed at reaching 74 million children, to be supplemented with mop-up campaigns on any importations.

As of 3 August, 30 of 37 states in Nigeria were still infected and 430 cases of polio were reported, posing the highest risk to the end of 2004 target for the global eradication of polio. On 31 July, the first round of four-day immunization activities resumed in Kano. Campaigns during the national immunization days, from September to November across the country and particularly in Kano and surrounding states, will be necessary to prevent further spread of the disease.

Nigeria's Minister of Health Eyitayo Lambo outlined the steps his country will take to dramatically improve polio campaigns in the first half of this year, particularly in the northern states where the virus continues to circulate widely. "We will work together as one-federal, State and local governments, religious and traditional leaders, Christians and Muslims-to reach every child with the polio vaccine", he said. In India, there has been an 84-per-cent reduction in polio cases in 2003 compared to 2002. India's Minister of Health Sushma Swaraj stated that each and every child will be vaccinated, particularly in western Uttar Pradesh, and any other corner of India where transmission has not been stopped.

The World Health Assembly at its annual meeting in May 1988 resolved to eradicate polio from the world. When the Global Polio Eradication Initiative (GPEI) was launched that year, wild poliovirus was endemic in more than 125 countries, paralysing more than 1,000 children every day. The GPEI, spearheaded by national governments, the World Health. Organization, Rotary International, the United States Centers for Disease Control and Prevention (CDC) and the United Nations Children's Fund, is the world's largest public health initiative ever. The polio eradication coalition includes: Governments of countries affected by polio; private foundations, such as the United Nations Foundation and the Bill & Melinda Gates Foundation; development banks, including the World Bank; donor Governments, which include Australia, Austria, Belgium, Canada, Denmark, Finland, Germany, Ireland, Italy, Japan, Luxembourg, the Netherlands, New Zealand, Norway, the United Kingdom and the United States; the European Commission; humanitarian and nongovernmental organizations, such as the International Red Cross and Red Crescent Societies; and corporate partners, including Aventis Pasteur and De Beers.

Since 1988, 2 billion children have been immunized as a result of the commitment of more than 200 countries and 20 million volunteers in developing countries, backed by an international investment of $3 billion. Only 677 cases of polio were reported in 2003, representing a greater than 99-per-cent reduction in the disease. As of 20 July in Asia and North Africa, there were only 45 cases this year compared to 131 during the same period in 2003. However, transmission in sub-Saharan Africa is five times higher this year than last, with 365 cases reported to date compared to 78. If the GPEI is successful, polio will be the first disease to be eradicated in the twenty-first century.

A setback last year was due to funding shortfalls that caused most polio-free countries to stop their immunization campaigns, leaving millions of children more vulnerable to infection from endemic countries. An additional $150 million from public and private donors for activities during 2004 and 2005 will be required to fully implement the eradication plans outlined by the ministers of health.

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At the 10th session of the Islamic Summit Conference held in Putrajaya, Malaysia on 20 October 2003, heads of State and Government from 57 countries adopted a resolution, which was presented by the Government of Malaysia and other members of the Organization of the Islamic Conference (OIC), urging polio-endemic OIC countries to accelerate their efforts to wipe out the disease. It also calls on the international community, including OIC members and philanthropic organizations in the Islamic world, to come up with the necessary funds to stop transmission completely by 2005.

"OIC countries have demonstrated their resolve to protect their children against polio, with 51 of its 57 member States already polio-free", according to Dr. David Heymann, representative of the WHO Director-General for Polio Eradication, in addressing the delegation at the Summit. He also said that the remaining endemic countries are endangering children in polio-free areas and that three previously polio-free OIC member States were reinfected, demonstrating again how important it is that they finish the job.

Reported by Erika Reinhardt