The world is close to eradicating polio, but countries need consistent vigilance including informed media coverage to reach this goal.
The latest report of the independent board set up to monitor the Global Polio Eradication Initiative (GPEI), released last month ahead of this week's World Polio Day (24 October), confirms fears that the initiative is unlikely to achieve its target of ending polio transmission by the end of 2012.
Apart from Angola and India, five other countries with persistent transmission of the wild poliovirus have already seen more cases of the disease in 2011 than in the same period of last year. Afghanistan, Chad and the Democratic Republic of the Congo have each already exceeded their 2010 total.
The report also warns that surprise outbreaks will continue to undermine confidence in the global eradication programme. For example, China, which was polio-free for a decade, reported fresh cases this year in the country's north-west region. The strain responsible is genetically similar to the one circulating in Pakistan.
The detection of a case in Kenya is particularly alarming, the report says, as it represents a failure to deal with long-standing transmission between Kenya and Uganda since 2009. It also signals the potential of more cases to come, pointing out that the Horn of Africa is at particular risk of further outbreaks as a result of famine and political upheaval.
Political and social factors
Polio control in developing countries has received massive international support and funding, including free supplies of vaccines. In India, for example, public health analysts say that polio control has become a significant health intervention that runs parallel to and independent of their own health system.
Yet transmission of the virus remains. Clearly, there are problems other than funds. The GPEI report identifies the following issues as being common to countries experiencing control problems: inadequate political commitment; adverse parental beliefs and attitudes; weak 'micro-planning'; a lack of skills among local team leaders; geographical and social isolation; and poor problem-solving ability.
The refusal of parents to vaccinate their children has been a particularly sensitive issue. In Nigeria, for example, until two years ago, religious and political leaders in some communities insisted that polio vaccination campaigns were a ploy by the United States to 'sterilise' communities and spread HIV. Similarly, some Muslim communities in India feared that the polio vaccine caused infertility.
Governments of both countries have worked with academics, clerics and informal social groups to allay the fears. Nigeria's commitment to polio eradication and immunisation saw cases falling by 95 per cent, from 388 in 2009 to 21 by the end of 2010. But this year attention to polio has waned, leading to re-emergence of cases, which highlights the need for sustained communication and political commitment.
India: ahead of the rest?
India, meanwhile, is vigilant and hoping for the best. No cases have been reported since January this year the longest polio-free period so far in the country. But caution is still needed in view of the warning from experts thatthere is a high risk that any residual or imported wild polio virus will show upbetween July and November.
Control efforts have been active. For example, children of migrating parents have been immunised by mobile and transit vaccination teams working at railway stations, bus stands, running trains, markets, brick kilns and even religious fairs.
The India expert advisory group on polio eradication also rolled out a new communication campaign in 2011, which involved a personalised branding of messages that shifted from every child every time (for polio vaccine) to your child every time and my child every time.
But the GPEI monitoring board notes that other countries are lagging behind. For example, it says that Pakistan which is now reporting more cases than Afghanistan, India and Nigeria combined has made little progress over the last 18 months, and needs a fundamental strategy review.
One obstacle has reportedly been propaganda by Taliban militants in northern Pakistan that polio vaccination is a US-led conspiracy designed to reduce fertility rates, a similar argument to those that surfaced in Nigeria and India.
The Pakistan government has been showing stronger resolve in the past few weeks. Authorities in the Khyber Pakhtunkhwa province, for example, which borders Afghanistan, have warned parents not to accept the Taliban's position, and announced they would take action against those trying to stop polio vaccination.
The efforts of the Afghanistan government have been praised by the monitoring board, which describes the country's programme as strongly managed and innovative. But it also points out that it is still unable to reach one-third of children in 13 high-risk districts.
Journalism and vigilance
Continuous resolve is particularly crucial in the wake of growing concerns about the re-emergence of the virus in regions where it was previously absent, as well as countries that are slipping back on their progress in controlling the disease.
Health officials and journalists need to understand why a campaign is faltering in certain areas, and tailor their actions and messages accordingly. Only then will the world take the final step towards being free of this crippling disease.
Polio offers a demonstration to all concerned that disease control efforts often cannot be neatly isolated from social, economic, political, ideological and religious factors.
Journalists need to combine information about an outbreak the strains and number of cases, for example with a deeper understanding of, and sensitivity to, these underlying issues.
They need to communicate positive messages about polio vaccination that take into account how community sensitivities affect outreach work.
Re-emergence of polio also holds a lesson on the perils of complacency. As long as transmission is not fully under control, the absence of cases for a year, or in China's case a decade, are only signs of progress towards the ultimate goal.
This year, Nigeria has learnt that constant vigilance is necessary until the disease is eradicated. India, Pakistan and other countries should take heed. Until then, public health interventions and messages tailored to local conditions need to continue unabated.
T. V. Padma
Regional coordinator for South Asia, SciDev.Net