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Poliomyelitis is an acute infectious disease caused by the poliovirus. "Polio is a viral disease. It’s a RNA virus that is transmitted from person to person through fecal-oral transmission." Dr. David Sniadack "Polio is unique. It can happen only in human beings -- not like malaria, not like diseases that happen in animals. This is truly a human disease. Human beings carry it. That's why we have eradicated smallpox, a similar disease, and we know that we can eradicate polio." Dr. T. O. Kyaw-Myint "Polio is really very much a disease of children. First of all, this is the disease which spreads by what we call the fecal-oral route, so contaminated food or water can spread this disease, and children, of course, are the ones who often are most likely to have the least sanitary of habits and thus most efficiently transmit the virus between themselves. As a result, if you stop transmission of this virus between young children, you will stop transmission in a population." Bruce Aylward Dr. David Sniadack "The virus lives in the guts of a child. If there are 5 million children and five children are missed, maybe the virus is present in the guts of one of those five missed children. So it will again circulate, multiply and circulate. And the vaccine is easy: just drops. If it was an injection it would be harder." Dr. Mohammad Iqbal Khalil "Something like 95 percent of all the people who get polio are under the age of 5. They’re all little people. Some are 4, some are 3, but some are 2 and some are 1, but they’re little people and I say they’re the most defenseless part of society." Bill Sergeant "Over the last two years now, we’ve seen the poliovirus become more and more localized geographically, but also more localized in high risk groups. Now, for example, we know that urban poor people who are uneducated form the highest risk group for developing polio, of any of the people of Pakistan. The Afghan refugees also form a special high-risk group. Children who live in crowded, poor conditions with poor sanitation and lack of good water supplies are more likely to be exposed more frequently to the poliovirus if it’s in the community. If you think about the children we still have to vaccinate -- these are the marginal children of society. These are the poorest, coming from the least educated families, from the ethnic groups with the least resources and the least access -- these are the most difficult children to reach in the whole country. That's why they’re still out there getting polio." Dr. Anthony Mounts "More cases are in highly congested areas, with poor sanitary habits and a lot of movement in and out of town. If you match it with the population density map, the cases are coming in from areas which are very, very densely populated." Dr. Hameed Afridi "If a child somehow ingests the virus, that virus will then reproduce in the child's intestines and then is absorbed in the intestines and travels to the nerve cells in the spinal cord, sometimes even in the brain. It has an affinity to receptors in the spinal cord, and there it does its damage. It decimates nerve cells of the spinal cord and you become paralyzed." Dr. David Sniadack What are the long-term effects of paralysis? "It’s a terrible crime to have paralyzed children who are going to be, in a sense, crippled and deformed for life. It's going to have a big impact on their life and what they can do in their life. They don't have access to crutches, to a wheelchair, or to braces. And in many cases they're also denied an education. The child can’t walk to school and the parents are working, so they can't carry her. In a country like Angola, polio excludes you from so many things. Chances of marriage are very, very slim because people aren't going to want to marry somebody who can’t work. Your chances of supporting yourself in a country where it’s mostly agrarian farmers who rely on physical labor are extremely limited if you are paralyzed. If you are a child, you can’t play with the other children. So many things." Lee Losey "Any time you have a child who is unable to grow healthily and a child who is unable to contribute to a family structure, you have an enormous burden and toll on the family." Jeff Ashley "They end up doing very menial jobs if any at all: selling newspapers, begging. There are not many resources to help them. If they live in the rural areas, it’s a terrible situation. I’ve seen these people just dragging themselves though the dirt and begging, and they just look like they’re living in horrible circumstances. Of course, the women would never even be allowed out of the house if they were paralyzed. They’d have no hope of ever being married or having a normal life. They would be totally dependent. It’s a very tragic situation. When you drive around Pakistan, you see newspaper vendors on the street -- they walk along with crutches and little withered legs. Or you see men who are peddling tricycles that they peddle by hand. These are all polio victims." Dr. Anthony Mounts What conditions cause the spread
of polio? "The virus is directly related to your exposure of fecal material. So in the developed world, of course, the exposure is much less than in the developing world. If you have no access to clean water you’re at higher risk than if you have access to chlorinated water. But even in the developed world the process of changing diapers can expose you to the virus. So, even things that we consider relatively routine do present a mechanism for transmitting the virus. Most of the adults, however, are immune, so they’re not at risk of disease. But if you have other children playing together and contaminating toys that are shared, then the virus can be spread that way. Therefore, in daycare settings or equivalent, the viruses can indeed spread. The risk is directly related to the social situation and the infrastructure of a community." Dr. Mark Pallansch "It’s the 21st century and still we are lacking a sewage system. The majority of our areas have no safe system at all. They depend on septic tanks. That creates a problem, because our underground water is spoiled, it’s polluted. You can’t trust our underground water, which is supposed to be safe drinking water. This is an enormous problem. We have to take care of this problem if we want to get rid of infectious disease." Dr. Mohammad Iqbal Khalil Who are some famous polio survivors?
"We use eradication of a disease to speak of completely getting rid of it. That is, that the disease does not exist anywhere within a country, and then finally any place within the world." Lee Losey Why is polio targeted for eradication? "There are some characteristics for a disease to be eradicable, like it infects only human beings so that there is no animal reservoir for that infectious agent. It's transmitted only from person to person without the intervention of a mosquito or the environment. And if you survive after the infection you have immunity forever, so you don't get sick again. And you have a good intervention like a vaccine." Dr. Ciro de Quadros "By eradicating polio, we prevent over 350,000 cases of paralysis a year and that offers these children a full life -- if they can walk, if they can be part of their community, if they can earn a livelihood, if they can marry and have children of their own." Ellyn W. Ogden "To eradicate a disease like polio, you have to stop the transmission of the wild poliovirus. You do that by immunizing all the children in the world against the disease. You hold National Immunization Days, where children and mothers and fathers come to a center and they get immunized. You also do house-to-house strategy. You go out into the villages or into the communities and you knock on all the doors, and you ask them to bring out the children and immunize those children. And you mark the house with chalk to say this house has been immunized." Carol Pandak "Polio eradication is largely a matter of logistics. You basically have to do two things. You have to vaccinate 90 percent of all children under 5. And that's largely logistics. Then you have to do good surveillance. That is, you have to find the cases. To find the cases you need to be in the communities. That’s where the non-governmental organizations (NGOs) are. They've got volunteers out in the communities doing all kinds of public health work." Lee Losey "What we’re trying to do is to get enough vaccine out into circulation, circulating among the population so that the virus has no place to go. The wild virus will die out in a matter of weeks if it’s got no place to go -- if it can’t re-infect another child. So by vaccinating all of the children in the community, you create a barrier to the virus and it goes away. So we have to tell people, we have to make them understand that even if their child is protected, or if their child got vaccinated in the last campaign, they still need to get vaccinated in this one. Because it's for the good of everyone. And if they don’t get vaccinated, then we’ll never stop this disease from spreading." Dr. Anthony Mounts "If the only cases that ever occur of polio in the future are vaccine-derived cases, I think the public health community is entirely justified in trumpeting its success in eradicating the natural occurrence of this disease." Dr. Ronald Waldman How is global eradication certified? "The first thing you have to do is eliminate the disease so you don't find it anymore. But then you have to monitor for another three years to make sure it's not there, so you can certify that it's gone. Maybe you've missed some cases, maybe there are some villages that didn't get to it, maybe there are some people on an airplane that didn't get vaccinated. So, it's about three years after the elimination of polio that we can then declare that it has been eradicated." Tim Wirth How does this effort compare to smallpox eradication? "Polio eradication is more challenging than smallpox for several reasons. One, the number of countries that were endemic at the beginning of the program was much larger than at the start of the smallpox eradication program. Polio eradication actually consists of eradicating three viruses, not just one, as with smallpox. The other problem is that poliovirus infection does not always cause disease in the patient it infects. Smallpox always has clinically evident disease. So just by looking at a patient, one is able to track the smallpox virus. Whereas with poliovirus, you can have hundreds of infected individuals before you will ever see a child paralyzed. The surveillance activities are much different for polio than they are for smallpox." Dr. Mark Pallansch "I think it’s difficult to say which is more challenging: smallpox eradication or polio eradication. But the programs and the challenges are fairly different. We have a much bigger global population than we had in the 1960s and 1970s, when we were trying to eradicate smallpox. Many new conflicts have arisen since we launched the eradication initiative against polio. You’ll remember that 10 years ago, much of D.R. Congo was not at war. Much of Afghanistan was a lot quieter than it was in the last couple of years; similarly, Somalia. With polio, because it can spread so fast to anywhere in the world, we have to maintain a global surveillance program, we have to maintain global immunization, we have to maintain massive immunization days in countries that have been polio-free for relatively long periods." Bruce Aylward How do we know if the eradication campaign is working? "There’s a set of criteria for polio certification. An outside body is going to come in and look largely at the surveillance system that a country has. You expect one case of acute flaccid paralysis in every 100,000 children under the age of 15 in a normal population if there’s no polio. So a test of whether or not you’ve got a strong surveillance system is if you are finding that one case of paralysis in every 100,000 children under 15 in a nation. That’s an indicator of whether or not your surveillance system is good. Another indicator of a strong surveillance system is that you not only find the paralysis cases, but that you find them within two weeks of onset in order to do the laboratory analysis of the stool sample to tell whether it's polio or not." Lee Losey "Surveillance is the eagle eye through which you can assess your health system. It helps us plan for the future. I think this is the most useful thing that has come out of the polio campaign." Dr. Hameed Afridi "Surveillance tells us how we’re doing. You know, how we need to fine tune our efforts. And where we are along the timeline for polio eradication." Dr. Olen Kew "Surveillance is not something that stops during the last campaign of our National Immunization Day. Surveillance mechanisms are extremely important to monitor and track and ensure that we are not seeing anymore cases." Jeff Ashley What is the legacy of polio eradication? "I think that maybe the single most important legacy of polio eradication is the end of acceptance of the continued incidence of vaccine preventable diseases in poor countries." Dr. Olen Kew "When we look at the legacy of polio eradication, I think we have to try to ensure that we do more than eradicate this disease. We have to ensure we reach every child, every community, and eradicate the disease. By doing so, we open a door to bring more things, to bring anti-malarials, to bring bed nets to protect children against malaria, to bring clean water, to bring surveillance for other important diseases. That must be our goal: not only to eradicate the disease, but to help communities help themselves to do a lot more for the children." Bruce Aylward "An immediate legacy of polio eradication will be a reinforcement of the commitment to eliminate and eradicate measles, and I can tell you from my own experience that in the developing world, the people are waiting for us." Dr. Olen Kew "I think the legacy of polio -- and what it has contributed in the broader strengthening of health systems -- is very, very complex, and can be measured in many, many different ways. One small thing that polio eradication has done has been to include vitamin A in many of the polio immunization days. Just that simple thing of adding vitamin A drops has prevented, we estimate, over a million childhood deaths in the last few years alone. So in many, many ways, whether in terms of investments in the broader health systems or actual outcomes, we believe that the polio eradication initiative has had a real impact. In the closing years of the polio eradication program, we have to make sure now that the infrastructure we’ve established -- the institutional arrangements, the human infrastructure, the physical infrastructure -- that we build on all of that and we structure it in a way that it can continue to contribute to many other areas of immunization, of surveillance and broader health work." Bruce Aylward "USAID has always focused on trying to mitigate conflict, to try to establish systems and provide services that will encourage a transition to peace and a stable government and democracy over time. And we feel that polio eradication contributes greatly to those goals." Ellyn W. Ogden "The benefits are larger than you might think. The obvious one is the fact that we won’t have to vaccinate for polio anymore. So all the resources that are spent buying polio vaccine, distributing polio vaccine -- all of this can be diverted to something else. But the biggest benefit to society is: people who are crippled from polio, especially in places like Pakistan, they’re not productive, contributing members of society. It takes a lot of money to support them. And this can be fixed, this can be prevented. There's also the savings to medical budgets. It takes a lot of money to take care of polio victims. All of that can be reallocated for other needs." Dr. Anthony Mounts How will eradicating polio help fight other diseases? "[Once polio is eradicated,] it will be a great victory for the global public health network. A real sense of confidence will build a base for the next set of issues, which are malaria, measles and ultimately, of course, the huge challenge of working on AIDS around the world." Tim Wirth "We are learning that the efforts to eradicate polio in the poorer parts of the world, particularly in sub-Saharan Africa, are bringing a tremendous benefit for the health infrastructure. So I believe that because of polio eradication, the African countries will be in a much better condition to fight the HIV/AIDS epidemic." Dr. Ciro de Quadros "I think there are a lot of things we’ve learned from this experience that can be applied to HIV. We did the same thing with polio: we built on the experience from smallpox eradication. We used a lot of those lessons to plan polio eradication, and I think we’ll do the same with HIV. We’ve learned a lot about surveillance and community involvement, and I think these lessons can now be used, especially if there’s a vaccine for HIV developed in the near future, to implement some kind of control projects for HIV." Dr. Anthony Mounts "Hopefully there will be a cadre of people who have been brought into the public health system and hopefully there will be a heightened awareness of the importance of public health programs that there will be some transfer of emotion and expertise from the polio program to the ongoing efforts to control HIV/AIDS." Dr. Ronald Waldman "The experience with polio and the global program working together is a very positive one that we're going to have to draw on for dealing with SARS, because it's almost certainly going to be a problem we're going to be dealing with for a long time." Dr. D.A. Henderson "The world is tackling a number of things right now, like improved malaria, HIV/AIDS and tuberculosis control. I think polio has a lot to teach about how to maintain the political interest and partner/donor interests on those kind of topics, because I think polio has done a very, very good job." Robert Steinglass Have other diseases been eradicated? "The only effort so far globally that succeeded was smallpox, and now hopefully polio will be the next one. The others failed because the disease, from the outset, was not eradicable." Dr. Ciro de Quadros "There have been in history a number of efforts at eradication. It began with hookworm. It's moved on to yellow fever, to yaws, and malaria. Each of these have failed. When we got to the smallpox eradication program, there were many who said eradication itself was impossible. We did not believe that. We believed we could do it with smallpox. We did succeed." Dr. DA Henderson "The cold chain, which is a series of refrigeration and ice packs and other modes of keeping vaccine cold, is very important. From point of manufacturing until that drop gets into the child, we make sure that that vaccine is kept as cold as possible until we can give it and assure that it's in good quality. Manufacturers have agreed to use a little monitor on the vaccine vial. It's called a vaccine vial monitor marker. This little vial changes color with exposure to heat over time, and that lets us know if the vaccine is potent at the point of use." Ellyn W. Ogden "When we were involved in the smallpox eradication program, we had to create a system for preserving the vaccine. We call it the cold chain system. " David Newberry "Polio has brought in a lot of cold chain equipment. This is equipment to maintain the integrity of the vaccine." Robert Steinglass What are National Immunization Day's (NIDs)? "The National Immunization Days are days in which you immunize all the children in the country, under 5, on a single day. It's a massive effort." Bill Sergeant "An epidemiologist investigates epidemics or outbreaks, the underlying causes of disease. In our area, the epidemiologists are really adhering to the traditional role of epidemiologists for the last two or three centuries, which is to understand the underlying routes of infectious disease and the risk factors which permit the continued transmission of polio virus. What are the risks? What are the causes? And then what are the interventions? What are the public health steps that are essential to stopping the transmission or eliminating the risk of polio?" Dr. Olen Kew "An epidemiologist is often some kind of detective of disease, you might say. You are kind of a sleuth, a detective trying to look at the places, look at the clues and find a solution. If it’s a disease that has not yet been discovered, then you’ve got some signs to look at and you try to figure out what’s causing this. Who gets it? Where do they get it? What caused this? Once you’ve already got a disease, you bring in epidemiologists to use some of those same tools to let us know how we’re doing, where the disease is, are we eradicating it." Lee Losey "What we mean by herd immunity is if you vaccinate a certain percentage of a population that might be susceptible to the disease, then it will protect the rest of the population. If you visualize 100 people standing in a room within arm’s length of just the four people that are closest to them, if you immunized 90 percent of the people in that room (thus only 10 people randomly spread through the room have not been vaccinated), and you bring in one person with polio, the likelihood is that that person with polio is not going to come in contact with the 10 people who are not vaccinated. And if, by chance, the person with polio does come into contact with one of those 10 people, that person will be surrounded by other people who are vaccinated, so when the virus tries to pass itself onto the next person, it will be blocked. Different diseases require different percentages for herd immunity to be achieved. Ninety percent is what we think the target should be for polio herd immunity." Lee Losey What is the purpose of the global lab network? "The purpose of the laboratory is to distinguish those cases of paralysis that are due to poliovirus from all other causes of paralytic disease. The genomic sequencing of the virus will also tell information about where the virus came from, whether it's indigenous, a native virus to that country, or it's an importation." Dr. Mark Pallansch "You need a laboratory not only to identify whether it's polio or not that's causing the illness, but which type of polio. And for that a laboratory network has been built from the earliest days to support the initiative." Dr. Olen Kew "The lab work is part of a surveillance system. It is the eyes of the program. It is the attempt to look for where the wild virus is. And this is a system that is dependent on all of the steps, from identifying paralyzed children through having specimens collected and tested in a laboratory that is able to identify the presence of the virus." Dr. Mark Pallansch "There is always a challenge in building such a comprehensive global network where none has existed before. This is really the first time in human history that a worldwide network operating to uniform and high standards of performance has been built for any infectious disease, and there are a number of challenges with that. Most of those challenges have been overcome with the strong support of WHO and WHO’s partners. And of course with the virologists themselves in each and every country where there’s a laboratory that enthusiastically supports the idea of polio eradication." Dr. Olen Kew How is poliovirus contained in the laboratory? "The containment at this stage involves developing an inventory of those laboratories around the world that have poliovirus or have materials which could potentially contain poliovirus. So the inventory is the first phase. The second phase is to assure that those materials are handled in a safe way that does not pose a risk of the virus leaving the laboratory." Dr. Mark Pallansch "A great part of our work right now is to make sure that we have identified every laboratory in the world that still has poliovirus or still works with poliovirus or may still have the virus and not even know about it. So we have to identify those labs, survey those laboratories, and then with the help of those laboratories, establish a program to make sure that the viruses are appropriately managed, safely and securely stored, such that they will not pose a risk to their communities. This is a big job. It’s a massive logistical effort, but the work done today suggests that this is very, very feasible." Bruce Aylward "If you have hundreds of laboratories that have poliovirus in their freezers or potentially infectious materials, then it’s important as we get close to the last case of naturally occurring polio to determine through an inventory which laboratories do have samples, materials that may be a potential threat to the reintroduction of poliovirus after the last naturally occurring case." Dr. Steve Cochi "We're not looking at destroying every stock of poliovirus around the world. What we’re making sure of is that the barrier between that virus and the community is as secure as possible. And there are many, many levels to that barrier just in case one of those should break down. It is very, very difficult even now for a poliovirus to just leave a laboratory and re-infect a community. We have not seen that happen so far, even before we started this containment program." Bruce Aylward What is the "end game strategy"? "There are three or four scenarios. The first scenario will be that you will have a sort of global immunization day and then everybody stops vaccinating at the same day. We know from experiences in Cuba that after two or three months, the [vaccine] virus disappears from the environment. The second one would be that you'd have another vaccine with the live virus attenuated that would not have the property of reversion to virulence, which is very complicated. A third scenario would be that you would switch and replace the oral vaccine with the inactivated vaccine. And what we need now is to look into these scenarios and see which one really would work." Dr. Ciro de Quadros "Can you imagine getting every country in the world at this point in time to take a day, a week, a month, and vaccinate all our children? I don’t think so. There are so many problems in so many parts of the world, and so many agendas that different countries have, that this is sheer fantasy to believe that you could do this." Dr. DA Henderson "It’s like we’ve got the virus cornered. We just have to really move in and attack it hard this time. But it takes a massive effort. The children who we're trying to reach now are the ones who are least reachable -- the most marginal of society. And so we’ve got to push and push and push and throw a lot of manpower and a lot of resources into it. But if we can do this, the payback is going to be huge. Eventually we'll be able to stop buying polio vaccine and we can refocus on something else. If we can do this -- if we don’t give up here at the last minute -- if we can really do this, it’s going to have eternal benefits." Dr. Anthony Mounts Will vaccinations stop after eradication? "When we eradicate polio from the world, we'd like to stop vaccinating, because stopping the vaccination is the major gain that you have in terms of the savings, and of course you won't have anybody paralyzed anymore if you eradicate the disease. So when we eradicate polio, we want to stop vaccinating." Dr. Ciro de Quadros "There is now increasing talk not so much of eradicating polio but maintaining eradication. In other words, this will continue to require investments over time, and the likelihood of stopping polio vaccine, which is the big economic payoff of polio eradication, starts to recede into the distance unfortunately." Robert Steinglass "We're not going to be able to stop vaccination worldwide at any point in time no matter what we do. You're always going to have unvaccinated children. Are we then thinking that two years or five years later we will begin to have cases again as a result of reversion to virulence? I would say you have to think that. You have to assume that's going to happen." Dr. DA Henderson "Some events like September 11th, need to be considered. It's unlikely that many governments would agree to allow their population over time to become susceptible to serious disease by stopping vaccination." Robert Steinglass "Some scares related to smallpox have caused some concern about polio, which should not be a concern because they’re in completely different categories. I’ve often said that I didn’t think any self-respecting terrorist would ever choose polio, which, of the children it infects, only 1 percent are ever paralyzed. There are many agents which are much more serious." Bill Sergeant "Obviously, a virus which only causes one case of paralytic disease in 200 would seem to not be a very good biological weapon. But I would remind everyone concerned: suppose we stopped polio vaccination and suppose someone decided to reintroduce it. Back in the 1950s when we had polio [in the United States], in the summers we were closing swimming pools, we were keeping children at home, we were isolating families. We did many things because of the fear and terror that polio engendered, and the fact that it would cause paralytic disease in children of the wealthy and of the poor, even those who were in their teens and older. There was immense fear. Yes, polio could be used as a weapon." Dr. DA Henderson What are the effects on health infrastructure? "The polio eradication program has brought over a billion dollars in new money over the last 20 years to routine immunization programs. Those dollars have bought vehicles for much of sub-Saharan Africa and Asia for immunization and surveillance programs. It has bought refrigerators to store other vaccines in, not only polio vaccines. It’s trained hundreds of thousands of people to give polio vaccines and vitamin A and other simple health interventions. It's trained tens of thousands of health workers around the world to be able to investigate, detect and respond to other important public health problems." Bruce Aylward "If there’s one huge benefit globally, that would be the tremendous advances in laboratories. The international laboratory scene has moved into the 21st century, and that is a result of the polio eradication effort." David Newberry,
Senior Health Advisor "Because of the door-to-door campaign, the population now feels it is their right that everything should be provided them there. So for all other vaccination purposes, they don’t turn up at the health facility. That is one real setback that we had because of polio. But the positive things that have come out of the polio initiative have been so many, like the micro plan, the maps of every area. Everybody knows what they’re supposed to do, logistics training has happened. Surveillance is the main thing. We’re not just doing polio – we’re doing measles and tetanus already. And then this effort can be replicated for other purposes." Dr. Hameed Afridi "Many laboratories have been strengthened beyond a shadow of a doubt. Reporting systems, particularly for those diseases of epidemic potential, have certainly been strengthened -- just by virtue of so many people being out in the villages and so many extra eyes being able to see and record what's occurring with the health status of the population." Dr. Ronald Waldman What are the challenges of the immunization program? "The country borders are so porous that it is difficult to check who has been immunized and who has not been immunized. In the northern part of Niger, the weather is hot. And where you don't have electricity, it’s difficult to keep the oral polio vaccine in an acceptable temperature situation. Even if you have it for a little while, the potency is gone through the heat. Another challenge that we have is one of illiteracy. And another challenge is that there are nomadic people moving from one place to another, so you have got to be with them to be able to know who has been immunized or not." Jonathan Majiyagbe “The big challenge is competing. You’re competing in a world of so many priorities -- a world where so many good efforts that are ongoing need financing. And there's just so little financing going into public sector initiatives such as polio eradication, such as malaria, such as HIV/AIDS." Bruce Aylward "The great challenge has been where civil strife occurs, and those have been among the last countries for us to reach. Immunizing a child while people are shooting at you is indeed a very, very challenging problem." Bill Sergeant “Right now, Africa seems to be the melting point of a lot of conflict. You’ve heard about Congo, you heard about Angola, Sierra Leone, Liberia. All those areas have made it very, very difficult to have immunization. Agencies like WHO and the UN were able to broker days of tranquility. But then, what do you do in areas like Angola where you have landmines? Sometimes, Rotarians go to these areas, only themselves to be attacked by people living there." Jonathan Majiyagbe "Conflict countries are proving to be one of the most difficult areas for polio eradication. It’s not only a function of getting access into areas, but also a function of funding the activities that are needed. Typically, USAID and other donors do not put money into what we would call hostile countries." Ellyn W. Ogden "Sometimes, it almost feels like there’s a force out there that is resisting. Sometimes I think the force is apathy. That’s really what we have to overcome: the apathy. People are getting tired. They’re tired of all the campaigns. They’re tired of us coming back to their houses every six weeks. And that’s the force we’re fighting against: the apathy." Dr. Anthony Mounts "Funding remains the most serious challenge. Purchasing four-wheel vehicles to get back in very difficult areas and finding people who can take the vaccine back to the remote areas and deliver it. This turns out to be more costly than buying the vaccine itself." Bill Sergeant "We need women on the vaccination teams. This is because of the cultural restrictions. Strange men can’t enter a home where they’re not related. If there’s no male relative at home, a woman with a small child will not let a male vaccinator into the house. She probably will not even meet him at the door. That means we have to recruit women to be on the vaccination teams. This causes us some problems, because in some of the more conservative areas, they don’t allow their own wives and daughters to go out and move through the communities. We have to recruit women from outside the community. That adds another logistic hurdle." Dr. Anthony Mounts "Nomads and children living in brick kilns have always been seen by us as a special challenge. This is because they’re either moving, or they're so remote from the rest of the population. When you're making plans, those are not seen as regular places where people live, so they're not counted in the plans. Sometimes they're so far away that, even if a team is assigned, it's difficult to get there." Raana Syed "Logistically, there’s always a problem with transportation. We try and get volunteers and workers from within their own community, so that transportation is not such an issue. But there’s still the issue of trying to deliver the vaccine, the supplies, the ice -- all of the paperwork that needs to be filled out. It’s a very big logistical problem." Dr. Anthony Mounts Why are private organizations like Rotary important to the eradication campaign? "I think to include the humanitarian organizations, non-governmental organizations of a variety of sorts, is an extremely valuable instrument. I think it's because these are people working in communities who know the communities and who have a variety of different contacts as a result of programs that are already operating." Dr. DA Henderson "The pressure that's been put on by a private organization like the Rotary Foundation is in fact quite a good thing. I think that there is definitely something to be said for shaking up a public health establishment that was somewhat complacent about its ability to achieve remarkable things such as polio eradication. Increased demand from the lay community creates pressure to provide services. That kind of activism, that kind of insistence on better services for more people is in many ways what the donors ought to be hearing, not just hearing from the self-interested public health community." Dr. Ronald Waldman Is it appropriate to impose a global health initiative on individual countries? "If I am an administrator of health and you come to my country and want to encourage me to do something about, Guinea Worm, for instance, and I’ve got a stack of death reports on my desk from measles, diphtheria, tetanus, or any other disease, my obligation and my priority may be different from yours. At a national level, individual countries have their own priorities, and it's not fair, I don’t think, for us to dictate what those priorities should be. Nor should we take offense when they choose priorities that may be different than we on a global scale might suggest is important." David Newberry "It gives you just enough of the disease so that your natural immune system will recognize it and put up a defense when the real disease comes knocking, but not enough to make you sick. So you get just a small bit of the disease. And that's the case with polio. Now, there are essentially two kinds of vaccines. There’s live attenuated -- it's the actual virus, it’s the actual disease -- but it’s a very watered down version of it. So you take just a small bit." Lee Losey How does polio threaten nations already declared polio-free? "Every child's health is dependent on his neighborhood. The world is a big neighborhood now. And America is the same way. If we don't protect, if we don't do something about our neighbors in Pakistan, America is still at risk. And the same for every country." Dr. Anthony Mounts "The presence of a polio case in any part of the world will have implications for all the world. In this age of travel, where you can move from one country to another with such ease, you can carry a virus with you." Dr. Rahan Hafiz "Polio is a virus and as such, a virus does not know borders, does not know international borders, does not know provincial borders and does not discriminate against people, or children particularly. Poliovirus can jump any border, can jump any province and can infiltrate. The whole effort towards eradication in polio is to vaccinate as many children as possible to develop and increase that immunity so that the poliovirus cannot attach itself to that child and create disease. This is what is important to keep in mind: that any kind of virus or bacterial disease doesn't see borders and does not see human faces. It does not discriminate." Jeff Ashley Are vaccinators ever in danger? "One of the biggest fears of the program is that vaccinators lose their life or people working in the program lose their life. We don't enter eradication easily. People think that just by immunizing kids, it's all wonderful. But every day there are acts of bravery; every day people put their lives on the line for polio eradication. Many vaccinators have been killed trying to get vaccine out to kids in the farthest reaches of not only conflict countries, but anywhere that has remote access and can't get to children easily. Boats tip over, vehicles slide off the side of the road and sometimes people get shot. That is our worst nightmare." Ellyn W. Ogden "I'm amazed that people go out and do this, knowing that the area is at high-risk, knowing that they could be killed or wounded or robbed. And we do try to take precautions." David Newberry What happens if we stop vaccinating now? "If we stop now we would never be able to stop using the polio vaccine any place in the world. Because until you totally eradicate this disease, the day you stop vaccinating every child in the world for polio -- is the day it spreads back though the entire world. And we’re back in the same situation we were in the 40s and 50s. We're still vulnerable to this disease, and until it’s eradicated from the world, every country is going to be vulnerable." Dr. Anthony Mounts |
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