Persistence required for polio eradication

Today is World Polio Day. Perhaps you wonder: Why is this disease so important that it deserves a special day to attract everybody's attention?

Actually, because polio is a disease that has almost been eradicated, it is important to all of us. So far, the only human disease ever eradicated is smallpox, but we are close to eradicating polio next, provided we take this effort seriously.

What would be the benefit of eradication? For one, we can stop polio immunization, which would save money and effort for all countries. The cost of the polio vaccine itself is relatively cheap, but the cost of administering vaccines for all infants is high. I estimate that the annual cost of polio immunization in China exceeds 700 million yuan ($110 million) every year. There is also a hidden cost people may not be aware of, which is that the vaccine can have severe adverse consequences for a very small number of infants, perhaps one in a million. This problem will also go away once we eradicate polio and the use of the polio vaccine can be stopped.

Last year, there were only 1,500 polio cases reported in four countries, compared with over 350,000 cases in 125 countries more than two decades ago. In sum, we have made great progress towards eradication and we are near the home stretch, but as we learned from the smallpox eradication effort, this will not be an easy stretch. The remaining effort is like climbing Mount Qomolangma: the last few hundred meters is the hardest. Greater effort is required.

Right now, only four countries have polio in broad circulation - Nigeria, Afghanistan, India, and Pakistan. Three of them border China.

Through its immunization program, China had been polio free since 1999, until this past summer when a cluster of cases was detected in Hetian, Xinjiang Uygur autonomous region. It has been proven, through DNA evidence that the outbreak was due to an imported strain from Pakistan. Through the government's rapid and forceful response, this small outbreak was brought under control with no threat to the rest of China.

However, this outbreak illustrates the urgency of global eradication - China cannot rest if neighboring countries are still not polio-free. China must continue to fund polio immunization even if there is only one country in the world with the polio virus in circulation.

How close are we to eradicating polio? The optimistic estimate is 5 to 10 years, provided the effort for the final push is adequately funded and executed. The estimated cost is about $1 billion a year, a relatively small sum when compared with efforts spent on other health conditions. However, because of the impression that polio is a disease of the past, many countries are either not contributing or not contributing enough to this global effort.

For instance, the United States, which is contributing $5 billion a year in the fight against HIV, is only contributing $30 million a year for the polio eradication effort. Clearly, HIV has a much higher disease burden than polio. But on the other hand, if we look at the return on investment, the money we put into polio eradication over the next few years will result in far greater savings when the goal is reached - worth at least 50 times the current investment.

What can China do to help accelerate the polio eradication effort? There are several on-going efforts that China can build on. The first is the polio immunization and surveillance system China has in place today. The detection and prompt response to the imported polio cases from Pakistan is a good example of its successes. Further strengthening the system in remote areas can better assure China remains polio free. If China can provide technical or financial assistance to Pakistan for polio surveillance and immunization, it will not only contribute to the global eradication effort but also further secure China from outbreaks.

Another on-going effort in China is contributing to global polio eradication is the plan already in place to expand the production capacity and to improve the quality of polio vaccines - the essential tool that will still be required both before and a few years after the eradication goal is reached. Both the China National Biotech Group and Kunming Biological have active programs contributing to this effort, which will help to ensure the polio vaccine's global supply security.

Finally, approximately a dozen mainly developed countries are contributing to the polio eradication effort through a joint mechanism called the Global Polio Eradication Initiative (GPEI), which provides vaccine and operational support to poor countries. If China can also contribute to this initiative, it will stimulate more countries to join the effort. This certainly will help to accelerate the realization of a polio free world.

The author is China Representative of the Bill & Melinda Gates Foundation.

(China Daily 10/24/2011 page8)