POST 01342E: POLIO ERADICATION VS CONTROL—THE DEBATE CONTIN

POST 01342E: POLIO ERADICATION VS CONTROL—THE DEBATE CONTINUES FOLLOW-UP ON POSTS 01339E & 01341E 27 OCTOBER 2008 ****************************************** The topic continues to be hotly debated and perspectives seem to differ widely. For those of you who would like a statistical update on the number of polio cases country-wise, the following website has weekly updates: http://www.polioeradication.org/casecount.asp (Global Polio Eradication Initiative) -------- NEED TO PLACE THE FACTS ON THE TABLE To the Editor, Re: the Polio eradication discussion. I understand Hans' response is this way: eradication efforts have now become disease control efforts, i.e. the present efforts that originally were meant to eradicate polio, are now efforts to contain it and without much hope to eradicate it. Am I correct? However, could we not have some facts on the table: 1. what is the cost involved? the billions of dollars that Anthony mentions? 2. is it true that the number of wild polio cases is increasing? Which countries do still have polio (India, Pakistan, Afghanistan, Nigeria?) and if so, what are the number of cases in each country. Any website available where this information can be found? 3. how much does the routine immunization coverage suffer in the countries with Polio. A few years ago I spent long time in Afghanistan as well as in Nigeria and was horrified to see that there were no resources (staff and time) left for doing routine immunization after doing campaigns. In Afghanistan they had one almost every month. You could therefore conclude that children were perhaps saved from polio, but not from other more easily prevented diseases. 3. what is the opinion of the epidemiologists? Has SAGE said anything on this subject? Should this problem not be taken to the political level? What more can the international organizations do that they do not already do? The neighbouring countries to countries with polio are rightly worried that their territories will no longer stay polio free. Best regards, Mogens Munck ([[email protected]][email protected][/email]) -------- COSTING NOT MERELY IN CASH TERMS Polio is going the Malaria way. At least Malaria was and is even today a larger problem than Polio. Malaria needs to be controlled or eradicated IMMEDIATELY (over 1000 deaths in Jharkhand this year). So does snake-bite poisoning (over 1000 deaths in West Bengal every year). Also Rabies. Polio control at current levels is possibly as much as can be hoped for by the public. It would help immensely if the wasteful 21-day gap monovalent rounds 9 times a year, which disrupt health systems, were stopped. 496 paralysed children in India this year according to surveillance (excludes VAPP). If the international community were to help India give IPV as a routine vaccine (in addition to trivalent OPV if the roll-out takes time), that would be appreciated by Indian health workers as a good way to spend money. We need studies (overdue) to see if this approach can eradicate Polio. Costing in terms of total children paralysed (including VAPP) and not cash terms (which depends on exchange rates, inflation and other non-medical variables) would be more realistic. Prabir ([[email protected]][email protected][/email]) UNICEF -------- ILLOGICAL TO STOP ERADICATION: BUT USE THE RIGHT COMPONENTS Hello everyone I agree with Hans Everts that it would be illogical to stop eradication activities. It is really absurd that we speak of control when eradication is almost possible. What is the result of the so called control strategies that were supposed to be occurring before eradication efforts begin. Switching to control is throwing all children to risk from Polio. It is immoral and unethical to even discuss about control strategies now. We can re-look at what is happening with Malaria when by saying Control, we forgot it. Everyone will forget once Polio is going to be controlled and it is only the children who suffer. Again, I don’t agree with all components of eradication that violate the very moral and ethical nature of programme. These ethical dilemmas occur when one wants to complete the job of eradication as early as possible. I like mOPV since it has demonstrated scientific evidence to be effective against type 1 and there is no doubt that mOPV is a wonderful tool in this critical stage. But using only mOPV1 has resulted in 437 type 3 cases in India during 2008. Who is responsible for this? Should we not worry about these 437 children who might have been protected if tOPV was used. Or lets say, half of them would still have got type 1. Even then, it was lesser a damage than the current one. We face such dilemmas in public health programmes. But, on the whole, it would be better to get rid of this disease once for all. *And for all controllers out there*, have patience! The more pressure is created from others, the more problems the eradication programme is going to face. When I say this, the problems are not for those who run the programme but for the innocent children whose future is decided by Experts. It is scientifically proven that many countries have eradicated polio with the use of tOPV and IPV in the final stages. Even if it takes some time, I feel it would be better to follow the same strategy. I love mOPV but my love for children cannot be lesser than for this wonderful vaccine. Alternatively, tOPV should be used throughout the year and mOPV should be used only once before high transmission season and probably once or twice during high transmission season. Regards, Dr. Giridhara R Babu, ([[email protected]][email protected][/email]) MPH, PhD fellow FFP, Public Health Foundation of India Department of Epidemiology, UCLA, Los Angeles -------- In response to Dr. Varshney’s comments, Hans Everts writes: There is no point repeating my arguments. What about the swamps and gutters in Bangladesh, Latin America, China, Indonesia, Cambodia, Vietnam, the most part of Africa and last but not least southern India with about 75% of its population from where the polio virus has disappeared for many years now? Western UP, the most notorious place on earth in terms of polio eradication, was free of type 1 for more than a year until it came back from Bihar. Bihar itself, the second most notorious place, was free of type 3 for a long time. Swamps and gutters do not make it easier, but the above examples show the problems are not unsurmountable. With 95% of the global population, including rich and poor countries, countries in peace and in conflict, countries with high and with low sanitary conditions, living in polio free areas, the argument that eradication is impossible seems hard to maintain. Hans Everts ([[email protected]][email protected][/email]) Technical Officer WHO Geneva Post generated using Mail2Forum (http://www.mail2forum.com)