TWO SIDES OF THE SAME COIN

POST 01343E: WEAK ROUTINE IMMUNIZATION AND STALLING POLIO ERADICATION—TWO SIDES OF THE SAME COIN FOLLOW-UP ON POSTS 01339E, 01341E & 013342E 29 OCTOBER 2008 ****************************************** As a response to Mogens, no you are not correct. My whole point is that there are 2 options: (1) continue and finish eradication or (2) stop supplementary immunization (and surveillance, because that will collapse in no time) and accept the consequences in terms of re-emergence of polio in all countries with lower than excellent routine coverage. My whole point is that a control strategy would cost almost as much as eradication, but eternalise those costs and is therefore not a viable option. The argument that routine immunization suffers from polio eradication is mostly heard in countries where routine does not function in the first place. I will limit the enumeration of spin offs for routine: surveillance network, micro planning, considerably improved demographic knowledge of catchment areas, creation or revitalization of inter agency committees, renewal of cold chain, etc. It is an error to think that the time health staff spends on polio would otherwise be spent on routine. I won't deny that this may occasionally be true, but in the majority of countries where eradication stalls, the routine system was already weak. Weak routine and stalling eradication are 2 sides of the same coin and both represent a weak health system. One is not the cause of the other and if there is any causal relationship I would defend that the same causes that make routine weak, also hamper polio eradication. Countries that actively use eradication to boost routine are numerous. Much of Africa increased routine and eradicated polio at the same time by creating synergies. Polio staff work on polio and routine and are in many countries the pillars of the integrated surveillance systems. In northern India newborn tracking is done as part of campaigns and in high-risk areas newborns are followed up by local UNICEF staff to ensure they get fully immunized. This is not to suggest naively that there are no clouds in the sky, because there clearly are. It is to stress that: (1) alternatives for eradication are far worse than finishing the job and that (2) although the multiple rounds doubtlessly put a burden on the health system, the fact that they are necessary is symptomatic for weaknesses in the latter, because there where lessons learned from polio were used in other programmes, the benefits go way beyond the eradication of one disease. You can find more information at: http://www.polioeradication.org/ Best regards Hans Everts WHO Geneva Technical officer EPI Post generated using Mail2Forum (http://www.mail2forum.com)