When a massive earthquake ravaged northern Pakistan in October 2005, the initial aid provided to survivors in many areas came from highly trained World Health Organization (WHO) polio medical officers. In many African countries, it is these same polio officers who lead vaccination drives to crush other diseases, including hepatitis B and measles, and who detect outbreaks, like Marburg fever in Angola in 2004. While fighting to end poliomyelitis, thousands of polio medical officers have adapted their skills and duties to become vital cogs in national health networks. leading WHO officials fear that donors will stop funding the massive global network altogether after polio's eradication, resulting in the loss of a vital resource that is now crucial to immunization campaigns and outbreak responses in many countries. Our teams not only helped in the earthquake zone, but they also helped to develop guidelines for avian flu surveillance and now routinely collect data on measles and neonatal tetanus within their acute flaccid paralysis (AFP) work, Dr Nima Abid, WHO's polio team leader in Pakistan, told the Bulletin. WHO's diverse anti-polio approach, made possible by an annual US$100 million in funding under the Global Polio Eradication Initiative, has brought the disease to the brink of At the same time, it has helped to boost health services in many developing countries, reducing mortality and morbidity levels for measles, malaria and vitamin A deficiency in the process. Some 3300 AFP surveillance and response staff operate in 54 countries, along with thousands more polio communication and social mobilization workers. This is not a group that just detects diseases but it also responds, does local planning and mapping, gives vaccines to children and develops response mechanisms, said Dr David Heymann, assistant director-general for WHO's Communicable Diseases cluster of departments. With influenza, the polio officers could do much the same. But our fear is that as soon as the last case of polio occurs, it is going to be hard to maintain the funding to even continue the surveillance necessary to certify eradication. Polio remains endemic in Afghanistan, India, Nigeria and Pakistan, and there is a good chance that the virus can be eradicated in those countries within two years. Final certification and verification of the disease's demise is possible by 2013, said Dr Bruce Aylward, the director of the Global Polio Eradication Initiative at WHO. Governments, in conjunction with WHO and in line with the International Health Regulations 2005 (IHR), should use the slack provided by these next few years to permanently integrate as much of the polio network as possible into existing public health systems, Aylward said. Public health experts such as Heymann and Aylward agree that allowing the polio network to collapse would be akin to the tragedy of scrapping the smallpox surveillance system after the last case of the disease was reported in 1977 in Somalia. We must make sure we don't repeat the same errors when polio ends. It is a matter of finding the resources, Aylward said. The global polio network has become an integral component of national and regional health systems. Not only do its surveillance officers vaccinate against polio, but through the public-private GAVI Alliance--formerly known as the Global Alliance for Vaccines and Immunisation--they have also been able to rapidly introduce new and underutilized vaccines around the world, including for hepatitis B and Haemophilus Influenza type b (Hib). Polio field workers have also led the march in reporting and responding to other priority diseases, including measles and rubella. The efforts of polio surveillance officers have helped countries move closer to achieving Millennium Development Goal 4; by reducing measles mortality, the lives of more than 500 000 children are saved every year. …
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Apr 18, 2007
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