LONDON (AlertNet) - A global initiative to eradicate polio by the end of 2012 is not on track, due to a funding gap, weak political leadership in some nations and persistent problems with vaccination campaigns, a group of international health experts said on Wednesday.
In its second quarterly report, the Independent Monitoring Board of the Global Polio Eradication Initiative (GPEI) warned that, even though worldwide cases of polio have been cut by 99 percent since 1988, the disease will resurge if it is not completely stamped out.
Liam Donaldson, the monitoring board's chair and Britain's former chief medical officer, said eradicating polio by the end of next year is "still feasible," but requires more urgency and intensified focus.
"It would be a tremendous public health triumph, but failure to do so would have enormous consequences," he told reporters in London.
The initiative faces a shortfall of $590 million for its planned work through this year and next. So far, $1.36 billion has been pledged towards a total requirement of $1.95 billion for 2011-2012. To date, the partnership – which includes the World Health Organisation (WHO), UNICEF, Rotary International, the Bill & Melinda Gates Foundation and the U.S. Centres for Disease Control and Prevention – has spent $8 billion tackling polio.
"There are a number of richer countries that have called for polio eradication, but have barely supported it financially," the report said, without naming individual nations.
Polio is a highly infectious disease caused by a virus that invades the nervous system. It can cause irreversible paralysis in hours and mainly affects children under five. There is no cure, but it can be prevented by vaccination, which is the main strategy of the eradication campaign.
The number of cases per year fell to less than 500 in 2001 from 350,000 in 1988, when the GPEI was set up. But, over the past decade, the annual number of cases has spiked back above the 1,000 mark, totalling 1,294 in 2010. The stalemate has occurred even as annual spending to combat the disease has more than doubled to around $900 million.
Donaldson said eradicating the "final one percent (of cases) is proving enormously difficult."
OUTBREAKS IN 14 NATIONS
The latest report highlights the return of polio in countries that had been free of the disease. In four countries – Chad, Angola, Democratic Republic of Congo (DRC) and South Sudan – transmission has been re-established for 12 months or longer. Fourteen other nations have experienced shorter outbreaks since the beginning of 2010.
The number of cases dropped last year in three out of four countries where the paralysing disease is still endemic – India, Nigeria and Afghanistan. But Pakistan saw a 62-percent increase from 2009 to 2010.
The South Asian nation, where access for vaccinators has been hampered by pockets of violence and last year's flooding, has seen 54 polio cases so far this year, double the number recorded in the first half of 2010. The report warns that "Pakistan risks becoming the last global outpost of this vicious disease."
The polio-eradication initiative had hoped that two out of four endemic countries would be able to stamp out polio by the end of this year, but the report said this looks unlikely, as only India is on track to do so.
India has seen only one case in the first six months of this year, thanks to a response on an "immense" scale, it said.
One place where efforts are floundering is the state of Kano in northern Nigeria, which the report describes as "a smouldering risk that could yet undermine the whole eradication effort." Donaldson noted that polio had spread from Nigeria to 20 other African countries between 2006 and 2010.
The report also singled out Chad and DRC as countries of great concern. Chad, with 80 cases of polio detected this year, is now implementing a new emergency action plan. In DRC, which has recorded 59 cases in 2011, vaccination efforts are suffering from "widespread dysfunction" and a lack support from the president, the report noted.
The monitoring body highlighted how problems being reported with vaccination campaigns in the field are not reaching those who make decisions about the eradication programme, meaning they are not acted on.
They include falsified forms leading to exaggerated vaccination coverage and paid vaccinators who are sub-contracting their work to untrained children.
It also pointed to inconsistencies in the performance of the eradication initiative. Some countries have excellent vaccination campaigns that miss very few children, while in others "campaigns are carried out sporadically and consistently miss large swathes of children, leaving the population unprotected against the virus", the report said.
In Pakistan, there are also fears that reports the CIA carried out a fake vaccination campaign there during efforts to track down al Qaeda leader Osama bin Laden could hurt future immunisation drives, including a national polio campaign that was launched this week.
World Health Organisation spokeswoman Sona Bari told AlertNet last week that the agency hoped "this unfortunate story does not jeopardise the health of children" by deterring parents from getting their children vaccinated.
Asked about the potential impact of the alleged fake vaccination campaign on polio-eradication work, Donaldson was tight-lipped, saying only that it is a "concern" and the programme "is working on it."
"We hope we can resolve any risks to the programme," he added.
In the past, when false rumours have emerged about "improper aspects" of the polio programme – some Muslim clerics in Pakistan have denounced vaccinations as a foreign ploy to sterilise people, for example – community leaders have engaged with local people to explain its aims, Donaldson said.
(Editing by Rebekah Curtis)