POST 00931E : THINKING THE UNTHINKABLE

POST 00931E : THINKING THE UNTHINKABLE Follow-up on Posts 00917E and 00923E 27 May 2006 ________________________________________________________________ This posting contains three contributions. First Anthony Battersby (mailto:[email protected]) from the United Kingdom, defends further his ideas. Then Mogens Munck (mailto:[email protected]) from Spain, replies to Bob Davis. Finally Stanley Foster (mailto:[email protected]) from the United States offers his perspective of an "old wise man". We also inform you that the latest edition of Polio News of Spring 2006 including the technical tips is now available online at : http://www.polioeradication.org/polionews.asp ________________________________________________________________ Dear Claude, "Science" today has two articles that are germaine to this discussion. "Polio Eradication: Is It Time to Give Up?" Leslie Roberts, Science, 12 May 2006: 832-835, and "Is Polio Eradication Realistic?" Isao Arita, Miyuki Nakane, and Frank Fenner, Science, 12 May 2006: 852-854. The abstracts are available free-of-charge at : http://www.sciencemag.org/current.dtl There is a fee of $10 per article for the full text unless you already subscribe to Science. Dr. Isao Arita argues strongly that the emphasis should now shift from eradication to control. I have been told that the figure of $4,000,000,000 I cited is in fact only the cost of the international investment in polio eradication. The figure of $300,000,000 for smallpox eradication included the national contribution ($200,000,000). If this ratio is similar for polio then we are looking at a total so far of $12,000,000,000, two thirds of which is coming from the poorest countries in the world. And we are still years away from achieving eradication. As importantly is the time that country staff have to spend and which therefore means that they are not available for other health responsibilities. This burden falls entirely on national governments, so not only are the poorest countries being asked to spend ever spiraling sums on polio they are having to use precious time, time which is finite and thus not cannot be spent on other epidemiologically higher priorities such as TB, malaria and AIDs to mention but three. To respond to Bob, even Dr Strangelove did not imagine that somone would crash two planes into the World Trade Centre. Respond to today's reality and ask is the money and time being well spent? Take the good and sustainable things that the polio eradication effort has produced build on them and move on. We cannot afford to go on paying for yesterday's story. Many wise heads are giving us a message, let us listen to it and heed it. Anthony ---------------------------- Dear Bob, It seems to me that you are referring to the countries where the present strategies and approaches for polio eradication have been successful. What we (Anthony and I) really are concerned about, are the countries where polio has not yet been eradicated although the same strategies and approaches have been used, and in spite of much effort, work and availability of resources. I have given Nigeria and Afghanistan as examples. I myself am particularly concerned about the approach of going on year after year with NID – campaigns every second month, when the expected results are not forthcoming. Routine immunization is then often neglected, as staff at district - and below district level has too much to do, with the results that kids are not being fully immunized. Are we trying too hard to eradicate one disease? Is the disease burden of polio so big that immunization against other diseases can be neglected? Have some countries not protested against this bias? No wonder that one hear about the anecdotes of children who refuses to be immunized, telling the vaccinator that he/she has already been vaccinated 4-5 times. The risk of immunizing again and again the same children, but not finding and immunizing those who have not yet been immunized, seems to be considerable. Also, money can not buy all resources required. In some countries, particularly Afghanistan, suitable persons to be trained as vaccinators are hard to find, and the health clinics are far too few for the populations living dispersed and far away. The delivery process of immunization is therefore difficult. For that reason I find the approach taken up by European bi-lateral donors in for example Mozambique very interesting: each of the provinces have been “adoptedâ€