The Global Polio Eradication Initiative

The Poliovirus

Polio is an infectious disease caused by a virus. The poliovirus enters the body through the mouth and initial symptoms may include fever, fatigue, headaches, vomiting, and muscle and joint pain in the back and the limbs. In approximately one in 200 cases, the virus kills the nerve cells in the spinal cord that control muscles, causing weak and floppy arms and legs. The dead nerve cells cannot be replaced, and the result is usually lifelong paralysis. In severe cases, the poliovirus attacks the nerve cells of the brain and causes paralysis of the respiratory muscles, which leads to death.

Although anyone can be infected by the virus, more than 95% of all cases occur in children under 5 years old. There is no cure for polio, but effective vaccines to prevent the disease have been available since the mid 1950s and early 1960s. These include the inactivated (Salk) poliovirus vaccine (IPV -- used in the U.S.) and the more commonly used trivalent oral poliovirus vaccine (OPV).

Partners in the Global Initiative

In 1988, the World Health Assembly -- the governing body of the World Health Organization (WHO) -- resolved to eradicate polio from the world. The Global Polio Eradication Initiative (PEI) is spearheaded by WHO, Rotary International, the U.S. Centers for Disease Control and Prevention (CDC), and the United Nations Children’s Fund (UNICEF). The polio eradication coalition includes governments of countries affected by polio, donor governments, private foundations, nongovernmental organizations, and corporate partners. The U.S. Agency for International Development (USAID) is one of the initiative’s major technical partners. To date, through intensive vaccination campaigns, the PEI has reduced the number of polio cases worldwide from an estimated 350,000 cases in 1988 to 784 cases at the end of 2003. Approximately 5 million cases of paralysis have been averted since the launch of the global polio eradication effort.

Continuing Challenges

Poliovirus remains endemic in six countries (Nigeria, India, Pakistan, Niger, Afghanistan, and Egypt) and continues to pose a worldwide risk. Nigeria has the most infections, with 355 cases reported during 2003. Alarmingly, 10 countries in Africa, previously polio-free, have reported new cases of polio that are linked to the ongoing epidemic in Nigeria. Due to a lack of routine immunization, millions of children in neighboring countries are particularly vulnerable to the epidemic. WHO is planning to address this immunity gap by launching a synchronized immunization campaign in 22 west and central African countries in October-November 2004.

Generally, strategies for polio eradication include strengthening routine immunization services, national immunizations days (NIDs), and other special immunization campaigns that provide supplemental oral polio vaccine to all children under age 5. Surveillance for acute flaccid paralysis, the signal condition for polio, is conducted in virtually all countries, and stool samples from suspected cases are delivered to an accredited laboratory for poliovirus testing. After a minimum of 3 years following the last detected case of polio and after undergoing a rigorous certification process, the independent Global Certification Commission can declare the world polio-free for Polio Eradication.

Resources

The U.S. plays a significant role in the Global Polio Eradication Initiative by providing the largest share of external funding and technical support. Total external funding required for the program from 1988-2005 is estimated at $3.3 billion. From 1988 through 2005, the U.S. Government has contributed and pledged approximately 30% of the total Polio Eradication Initiative estimated budget. As worldwide interest in polio eradication declines in the face of a disappearing disease and competing priorities, the U.S. Government and other G-8 partners have nonetheless remained financially and politically committed to the eradication initiative. The polio campaign will require continued international commitment, as significant resources will be needed beyond 2005 to maintain immunization levels and implement post-eradication policy recommendations, including continued surveillance to verify polio eradication.