The race against polio: clearing the hurdles, crossing the finish line

Scott Leckman, a highly skilled general surgeon, has been our District Chair for the Polio Plus campaign for many years. No stranger to daunting challenges in the operating room or to giving orders to overcome them, he was a natural choice to lead this effort and to recruit Rotarians to join him on his multiple missions to India to defeat the spread of polio in that enormous developing country of 1.3 billion people.

I was privileged to be one of his recruits. India had its last case of wild virus poliomyelitis in 2011. The World Health Organization (WHO) declared it to be polio free in 2014. Scott and his Rotarian special forces absolutely deserve some of the credit for the massive and heroic immunization effort that led to the eradication of polio in this incredibly challenging environment.

The fight or the race, as I like to think of it, is not over. We could and should be in the last lap. Scott, however, has accepted a new challenge, to be our next District Governor. He has passed the Polio Plus baton on to me. I’m not a surgeon or a soldier. I was in the Public Health Service at the Centers for Disease Control during the Viet Nam War. My goal, then and now, is to eliminate infections that rob adults, children, and infants of their lives and livelihood. It’s an honor to be a part of the enormous willing, determined, and generous Rotarians who literally plan to run this awful disease into the ground. But it won’t be easy.

In India, every other country, even our own, we must maintain high levels of immunization in young and previously unimmunized children to protect them from the introduction of polio virus from a country where the virus is still endemic. There are now only two countries, Afghanistan and Pakistan, where this is the case. Fortunately, there have been only 8 cases in those countries this year, but that means there have been hundreds of asymptomatic infections in children who have acquired and may have transmitted the virus.

If eradication is to succeed there as it must, there are enormous hurdles to overcome. Much of the population is poorly educated and without access to diagnostic, preventive or clinical care. The governments have extremely limited resources and are unstable and ineffective in many parts of their countries.  Some local leaders are dubious or even antagonistic about an outside intervention. Closing this last gap will be especially hard and tremendously expensive. The effort to bring polio vaccine to infants and children in the small villages and cities of developing countries pays unexpected dividends. It often entails building clinics where volunteers and staff provide other vaccinations and clinical treatment.

On June 12th, global health leaders announced $1.2 billion in funding for polio eradication to 30,000 Rotarians at the Rotary International Convention in Atlanta, Georgia. At this pledging event, Rotary committed a further $150 million over three years to the cause. The Gates Foundation agreed to match this 2 for 1 and contribute $300 million. This will help protect more than 450 million children from the virus each year through vaccination and disease surveillance. That must continue for several years even after no further clinical cases are identified. That will ensure that children are protected until we are absolutely sure that the virus has been eradicated from human beings and from water and sewage. The new Director General of WHO, Dr. Tedros, said at our convention:  “The end of polio is now in sight.  This is the most critical moment of covering the last mile. We must keep our eyes firmly on the final goal.”

Joining us in our effort, the leaders of the G20 committed in their first Declaration on Global Health, “to strive to fully eradicate polio”.  The Chancellor of Germany, Angela Merkel, emphasized the benefits of preventive measures for the people and economies of all countries, especially the developing ones. The eradication of polio is projected to lead to savings of US$ 20 – 30 billion by 2035, making it an example of the economic impact that can be achieved through a focus on health.

~ Jay Jacobson, M.D., Emeritus Professor, Infectious Disease, U of Utah School of Medicine, Assistant District Governor, Salt Lake City Rotary Club

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