It is not quite time to declare it the ‘best of times and worst of times’ for the global effort to eradicate polio, but two new outbreaks of the infectious disease definitely puts a damper on the celebration regarding renewed international financial commitments.
Rotary International and the Gates Foundation recently led a fundraising conference that saw $1.2 billion in pledges for polio, nearly closing the $1.5 billion funding gap needed to pursue final eradication.
“It is humbling to see again the power of this incredible global partnership to generate funding to fight one of the world’s most horrible and debilitating diseases,” incoming World Health Organization (WHO) head Tedros Adhanom Ghebreyesus, a former minister of health for Ethiopia.
“The new pledges show that donors understand the urgent need to support this mission right through to the very end,” Tedros said at the close of the funding conference June 13. “We must finish the job properly to ensure that there is no chance of this terrible disease coming back.”
And then, just days later, polio came back.
Just days after global health leaders celebrated the new funding, the Democratic Republic of the Congo reported two separate outbreaks where four children were paralyzed by the virus. The likelihood of the disease spreading is high, warned the WHO because for every identified case of disease hundreds of others may be ‘carriers’ of the infection without showing symptoms.
The DR Congo outbreaks came a week after an outbreak was reported in Syria. Both countries had been considered polio-free by the U.N.’s global health organization.
Such setbacks continue to hamper the effort to rid the world of polio. Nigeria reported cases of polio in August, the same month the country was set to celebrate two years polio-free. The north of the country is cut off from the vaccines needed to stop the virus due to the instability caused by the Islamist terror group Boko Haram. It also makes it difficult for health officials to track the virus and when people are infected.
The story is similar for the Congo where rebel groups destabilized parts of the country and Syria which is in the midst of a civil war. It also makes it difficult for health officials to track the virus and when people are infected.
Rotary International almost singlehandedly made eradication a global goal. It got the U.N. in 1988 to set the goal of eradicating polio by 2000. There were 37 reported cases of polio last year, down from a peak of 350,000 cases per year in 1988. Pakistan, Afghanistan and Nigeria are the last countries with polio and all three share the same challenge of communities isolated due to conflict.
The Gates Foundation came on as a financial supporter to help the global effort as the eradication goal date was pushed back time and again. It turns out that getting to zero is not easy.
“We all have one big question on our minds. It’s something I think about all the time. Why has it taken so long?” Bill Gates said at the fundraising conference. “As quickly as progress is made, it can disappear.”
The foundation pledged to match every dollar Rotary raises over the next three years 2-to-1. That means Rotary’s goal of raising $50 million a year will equal $450 million, nearly one-third of what is needed for eradication. Pledges from the U.S., Japan, European Commission and others pushed the total to $1.2 billion, but that is still not enough.
Achieving the goal of eradication by 2020 requires an additional $300 million. Odds are the eradication date will continue to creep further into the future if the money is not raised.
“What happens if we don’t make the $1.5 billion? Polio will spread again, and if it does, it’s going to cost us billions of dollars and hundreds of thousands of lives a year in those vulnerable children we must protect against this virus,” John Germ, president of Rotary International, warned in October.
The cases in the Congo and Syria are different from the wild poliovirus that is still a problem in the three endemic countries. Circulating vaccine-derived poliovirus type 2, which is a form of the virus that is spread by some people after they are vaccinated, is the cause of the recent outbreaks. The same issue contributed to cases of polio in Laos, Myanmar and Ukraine in the past three years.
A consistently high level of vaccine coverage is necessary to prevent the vaccine-derived virus from spreading. The common link between the outbreaks in polio-free countries is poor vaccination coverage. Conflict in Syria and parts of the Congo make it hard to reach children with the polio vaccine.
The good news is that the injection of money will help monitor and prevent future cases. Tedros said the WHO will use some of the money to fund its disease surveillance work in more than 70 countries and to vaccine 450 million children each year. A round of vaccines in the parts of Syria and Congo where cases were discovered can stop the virus, but the underlying issues of poor infrastructure and conflict make it hard to prevent future vaccine-derived cases.
