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World: WHO Marks Milestone In Campaign To Eradicate Polio

  • Kathleen Moore

Public health experts from around the globe today officially declared the World Health Organization's European region polio-free. It means the crippling disease has been eradicated in 51 European countries -- from the U.K. to Uzbekistan -- and marks another milestone in the WHO's campaign to rid the entire world of polio by 2005.

Prague, 21 June 2002 (RFE/RL) -- For most people in the developed world, their closest brush with polio these days is the vaccination they get as a baby, or perhaps if they meet someone who was disabled by the disease as a child.

It wasn't so long ago that polio, or poliomyelitis, was a feared disease all over the world. Epidemics were commonplace, particularly in the summer, in the U.S. and Western Europe. And in some 10 countries of the world -- including Afghanistan -- this incurable disease still poses a real danger, particularly to children.

Polio can suddenly strike otherwise healthy individuals with distressing results -- severe breathing difficulties, excruciating pain, paralysis of the limbs, and even death. It is highly infectious, entering the body through the mouth and multiplying in the intestines. It often appears to strike at random, because it rarely causes distinctive symptoms, and only about one person in 200 suffers paralysis.

The disease mainly strikes children under the age of five, though adults can catch it, too. One famous sufferer was U.S. President Franklin Roosevelt, who caught it in 1921 at age 39 and was soon largely confined to a wheelchair.

The World Health Organization declared war on polio in 1988, launching a global campaign to make it the second disease in history -- after smallpox in 1980 -- to be eradicated.

Together with UNICEF, the UN's Children's Fund, and other organizations, including charity group Rotary International, their mass vaccination campaign has driven the incidence of polio to its lowest point in history -- with just over 500 cases reported worldwide last year.

Now, public health experts meeting in Denmark have officially declared the WHO's European region polio-free. This doesn't just mean the developed countries of Western Europe, but a vast geographical area reaching as far as Israel, the Caucasus, and Central Asia.

The announcement was made in Copenhagen today by the European Regional Commission for Certification of Poliomyelitis Eradication, an independent body of international public health experts. Marc Danzon, the WHO's regional director for Europe, hailed the announcement as a "tremendous achievement" in the global effort to eradicate polio. Bruce Aylward, the coordinator of the WHO's global polio eradication initiative, said he is in a celebratory mood.

"With this announcement, now more than 50 percent of the countries of the world and 50 percent of the people in the world are living in areas that have been certified as free of this awful disease, demonstrating conclusively that polio can be eradicated and polio will be eradicated from the world."

A 3,300-year-old Egyptian limestone carving showing a young man with a withered leg offers the earliest known indication of polio. UNICEF says that, at its peak, the disease killed or paralyzed half a million people a year.

The early to mid-20th century brought several key medical advances, starting with the virus' identification in 1908. One of the devices developed in 1929 to help polio sufferers was particularly imposing -- the so-called iron lung. This sarcophagus-like container covered the entire body except for the head. It kept people alive by "breathing" for them if polio destroyed the nerve that controls the respiratory system.

The 1950s saw more progress, with the first successful vaccine trials. In 1958. Albert Sabin was responsible for the oral vaccine, one of the breakthroughs that would make polio an all-but-forgotten disease in the developed world. He spoke at the time about the aim of his discovery: "... to give us tools with which to make life better, more dignified, richer and more worth living, not just for a few, but for as many as possible."

In the mid-1990s, polio was still endemic in some 10 countries in the Caucasus and Central Asia. And other European countries still have vaccination campaigns to guard against outbreaks, as Dr. Steven Wassilak of the WHO's Communicable Diseases Unit told RFE/RL: "The other countries in Europe had interrupted transmission some years ago, but in a few of those in Central Europe, from Ukraine down to Yugoslavia, former Yugoslav countries, we consider them recently endemic because there had been viruses in the early '90s that had been found. So for the potential possibility that there was virus still circulating there, there are also campaigns in those countries."

Certifying the region polio-free means that there have been no cases of "wild" polio virus for three years -- the last indigenous one was found in Turkey in 1998.

Still, there have been some recent polio cases in the region. Last year, the virus was found in a 5-year-old Azeri boy in Georgia and three young Romany children in Bulgaria. The difference there, from the WHO's point of view, is that the virus was identified as imported, in both cases coming from South Asia.

This illustrates how polio can cross borders and cause outbreaks in regions officially declared "polio-free."

Wassilak says one of the big remaining "reservoirs" of wild polio virus is in West Africa, the other is in the region of India, Pakistan, and Afghanistan. Both are in "challenging" areas, not least because of war or frequent cross-border travel.

"For India-Pakistan-Afghanistan, there are several related families of virus circulating, and they're all -- in particular for Pakistan and northern India -- in high density population areas, and the virus is very difficult to interrupt. So there are logistical and social problems that are complicating the vaccination of every child."

This is where National Immunization Days (NIDs) and so-called sub-NIDs -- district-level immunization days -- come in. NIDS are important because at one stroke they drive the virus out of a large "pool" of hosts that it needs to survive. Children need to be vaccinated several times to protect against the three types of polio.

Last autumn, 35 million children were vaccinated in Afghanistan and Pakistan in two rounds of NIDs. Afghanistan is planning a district-level immunization day on 23 July with two follow-up national immunization days on 10 September and 29 October. Tajikistan, Turkey, Turkmenistan, Uzbekistan, and Georgia are planning immunization days in October and November.

Today's announcement makes Europe the third region to be certified polio-free, after the Americas in 1994 and the Western Pacific in 2000. Wassilak says the target of a polio-free world by 2005 is on track -- though the campaign faces a shortfall of $275 million.

"It seems that with realistic planning and as long as the funds are available to do what needs to be done -- and that is a problem -- [the] low-intensity transmission countries can perhaps interrupt their transmission during the course of this year and that the high-intensity transmission countries may be able to interrupt it by the end of this year. So there's still the intention to try and stop all virus transmission as we get into 2003 and still be able to certify our polio-free status globally by 2005."

Until then, and probably for a decade or so afterward, routine polio vaccinations of children will continue.

(A calendar of National Immunization Days for individual countries can be found on the Internet at http://www.who.int/vaccines/siacalendar/postsiacal.cfm)

(Member states of the WHO European Region are: Albania, Andorra, Armenia, Austria, Azerbaijan, Belarus, Belgium, Bosnia and Herzegovina, Bulgaria, Croatia, Czech Republic, Denmark, Estonia, Finland, France, Georgia, Germany, Greece, Hungary, Iceland, Ireland, Italy, Israel, Kazakhstan, Kyrgyzstan, Latvia, Lithuania, Luxembourg, Macedonia, Malta, Moldova, Monaco, Netherlands, Norway, Poland, Portugal, Romania, Russian Federation, San Marino, Slovakia, Slovenia, Spain, Sweden, Switzerland, Tajikistan, Turkey, Turkmenistan, Ukraine, United Kingdom, Uzbekistan, and Yugoslavia.)

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