POST 00917E : THINKING THE UNTHINKABLE

POST 00917E : THINKING THE UNTHINKABLE 27 April 2006 ______________________________________________________________ Anthony Battersby (mailto:[email protected]) from the United Kingdom, shares thoughts and opinions on polio eradication. ________________________________________________________________________ Post 00799E presented a series of articles on the merits or otherwise of eradicating polio. Unless I have missed it this interesting series of articles does not seem to have provoked much discussion which is surprising. Since Post 00799E the following has been published: Mark Miller, Scott Barrett, and D. A. Henderson, "Control and Eradication." 2006. Disease Control Priorities in Developing Countries (2nd Edition),ed. , 1,163-1,176. New York: Oxford University Press. DOI: 10.1596/978-0-821-36179-5/Chpt-62. to be found at http://www.dcp2.org/pubs/DCP/62 This thought provoking document was prepared as a part of the Disease Control Priorities Project and raises major issues of concern. In Post 00868E Hans Everts said "When about 95% of the world's population, including 90% of Indian and 50% of Nigerian population, has not seen polio for a few years or longer, it is hard to maintain eradication is not technically feasible." Nearly one year on the world seems no nearer eradication and there are technical arguments (see Miller,Barrett & Henderson 2006) about its technical feasibility. The track record for disease eradication is not good, as Bob Davis points out in "THE TAIL END OF THE FUNDING CURVE". Smallpox eradication was the exception not the rule. The question that has to be asked now is: Is eradication of polio good value for money? One of the arguments for eradication is that immunization against the target disease can be stopped thus saving much money. However although smallpox immunization has been suspended, it has not meant that smallpox vaccine is no longer manufactured. In fact smallpox as a disease has gone, the virus has not been eradicated; it still exists in a few highly protected laboratories; there is a question over how highly protected some of those laboratories are, hence the fact that the USA has invested in large quantities of smallpox vaccine. The world we now live in is not the world that existed in 1988 when PEI was launched, the uncertainties are far greater and the possibilities for aggressive acts far more frightening. The end game for polio is proving an agonizing and very expensive struggle, which is deflecting attention from other pressing priorities. Countries have been lulled into a false sense of security by being declared polio free, when this happens it seems coverage levels fall hence the outbreaks in Indonesia and Yemen last year. The fact that the outbreaks were caused by importation from Nigeria is not the point, the populations were vulnerable when they should not have been vulnerable, they should have been protected by immunisation. The cost in money and time for both Indonesia and Yemen to control the outbreak was enormous and would not have been needed if routine immunisation rates had been maintained. The "at best" date for declaring the world free of polio is now mooted to be 2010, ten years after the original target. It is not surprising that the donors are beginning to reconsider funding to the eradication of polio. Is it good value for money? Smallpox eradication cost the world about $298,000,000. Polio has cost $4,000,000,000 so far and the shortfall in funds for 2006 alone is equal to the total cost of smallpox eradication. Of equal concern is the fact that it is unclear that immunization will actually stop once polio is declared "eradicated". The world has changed radically since 1978. Would Ministries of Health around the world dare to end immunization? Maybe, but based on the experience with smallpox they would not dare finally destroy the virus. How safe will reference laboratories be in the future? Safe enough to be sure that no virus from an "eradicated" disease will ever escape? Imagine the effect on a world free of measles if the reference virus were to escape by accident or be deliberately released. Much has been achieved from PEI which is operationally invaluable to immunization programmes. Now is the time recognise the profound changes that have taken place in the world since 1988, to recognise the analysis made by Miller, Barrett and Henderson and heed the advice given by Isao Arita, John Wickett and Miyuki Nakane and focus on control instead of eradication. By so doing health ministries will be able to capitalise on the useful operational lessons PEI has taught them without struggling with ever spiralling costs pursuing an ever receding target. GIVS sets out a vision of the future for immunization. This vision will take substantial resources, both financial and human if it to be achieved. Money and time spent on attempting to eradicate polio is money and time that cannot be spent on other priorities. While it may be argued that money can always be found, people's time is finite, for example if it is spent on NIDs it is not available for routine services, this has been well demonstrated in Nigeria. Please let us move on to the GIVS agenda and not allow it to be impeded by the millstone which polio eradication has become. Anthony ______________________________________________________________________________ Visit the TECHNET21 Website at http://www.technet21.org You will find instructions to subscribe, a direct access to archives, links to reference documents and other features. ______________________________________________________________________________ To UNSUBSCRIBE, send a message to : mailto:[email protected] Leave the subject area BLANK In the message body, write unsubscribe TECHNET21E ______________________________________________________________________________ The World Health Organization and UNICEF support TechNet21. The TechNet21 e-Forum is a communication/information tool for generation of ideas on how to improve immunization services. 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