Posts or Comments 19 March 2024

Archive for "Polio"



Elimination &Health Systems &NTDs &Polio &Surveillance &Trachoma Bill Brieger | 29 May 2022

When is Disease Elimination not Elimination?

A May 28th press release from the World Health Organization states that, “Togo eliminates trachoma as a public health problem.” The article explains that …

Validation of trachoma elimination as a public health problem in Togo was based on evidence. Several population-based trachoma surveys were conducted starting from 2006 to 2017. The 2017 survey using WHO recommended methodology found that the prevalence of key indicators was below the WHO trachoma elimination threshold. There was also evidence that Togo’s health system is able to identify and treat new cases of late complications of trachoma.

This raises the question, is Trachoma gone from Togo or does trachoma continue to exist at some low level whereby, as WHO notes, Togo has joined, “12 other countries that have been validated by WHO for having eliminated trachoma as a public health problem.”

This description of disease elimination contrasts sharply with the global concerns when “health authorities in Malawi have declared an outbreak of wild poliovirus type 1 after a case was detected in a young child in the capital Lilongwe. This is the first case of wild poliovirus in Africa in more than five years.” Wild polio virus had been declared eliminated in Africa, and just one case in one country grabs international attention.

Would one case of trachoma tomorrow receive the same concern in Togo? Apparently not according to the WHO definition, “Elimination of trachoma as a public health problem is defined as: (i) a prevalence of trachomatous trichiasis (TT) “unknown to the health system” of < 1 case per 1000 total population; and (ii) a prevalence of trachomatous inflammation-follicular (TF) in children aged 1–9 years of < 5%, in each formerly endemic district.”

So, while no cases of smallpox, guinea worm or polio would be tolerated after elimination has been declared, parents of a child who develops trachoma in Togo tomorrow would be told that your child’s case is only 1 in a 1000 and not of concern to public health. The caveat is though that “the health system (must be) able to identify and manage incident TT cases.” Presumably, if such management capacity does not exist, the disease in question could spread and elimination would be eliminated.

Another Neglected Tropical Disease, Lymphatic Filariasis, faces the same challenge in terms of elimination status. WHO explained in its guidance that, “In 1997, the 50th World Health Assembly resolved to eliminate LF as a public-health problem (resolution WHA50.29). In response, WHO proposed a comprehensive strategy for achieving the elimination goal that included interrupting transmission in endemic communities and implementing interventions to prevent and manage LF-associated disabilities The LF guidance stresses “Effective monitoring, epidemiological assessment and evaluation are necessary to achieve the aim of interrupting LF transmission,” or in a word Surveillance. There is clear concern for “absence of transmission” and worries about “recrudescence.”

While polio has a vaccine and guinea worm relies on providing safe community water, LF and Trachoma elimination depends on mass drug administration (MDA) at planned intervals until such time as transmission is reduced. All require a strong health system to implement, but the challenges of maintaining MDAs until such time as elimination has been validated is somewhat more challenging. In this context the communication is extremely important. Just because WHO validates the elimination of a disease as a public health problem, does not give policy makers license to ignore that disease. Advocacy is continually needed such that even after apparent elimination, neglected diseases will not be forgotten and health systems themselves not neglected.

Polio Bill Brieger | 10 Mar 2020

Leading the Final Push to Polio Eradication

Sophia Shea and Sophia Winchester have shared their thoughts about what  may hopefully be the final stages of the polio eradication effort. Their original blog appears on the website for Social and Behavioral Foundations of Primary Health care.

Polio eradication has been on the world’s agenda for decades, and we are finally at the last push to eradicating the disease.  However, Afghanistan and Pakistan remain on the frontlines of battling polio with added political tensions and suspicion against vaccination efforts.

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Child getting vaccinated from a polio mass vaccination campaign worker. Source

Both Afghanistan and Pakistan have experienced political strife surrounding the involvement of the Taliban.  While the Taliban supports polio eradication, they continue to battle with the WHO on how best to vaccinate the respective populations. In the past, Osama bin Landen was captured using spies in a door-to-door vaccine effort, which contributed to distrust among the community. The Taliban is strongly against door-to-door vaccination given this distrust; however, the WHO considers door-to-door to be bet practice and most effective.

There are religious leaders who also say that vaccination goes against Muslim law. Due to the increased religious pressure against vaccination, the Council of Islamic Ideology (CII) has released religious fatwas in support of vaccination and hopefully will promote vaccination in mosques.

Despite issues in governance between the Afghanistan/Pakistan governments and the Taliban, organizations involved in the Global Polio Eradication Initiative, such as UNICEFRotary International, and the Bill and Melinda Gates Foundation have been actively campaigning for mass vaccination efforts.  In order to adequately support this initiative, it is critical that there be clear leadership and fully supported funding streams to direct this final push for eradication.  Strict leadership by a governmentally neutral organization like the WHO will allow actors involved in this initiative to focus on their respective operations.  Finally, polio eradication is estimated to cost nearly $4 billion over the next few years, and the financial requirements of this effort should not create a barrier to achieving the overall goal of eradicating polio.

Call to Action:

We are very close to eradicating polio from the world – Pakistan and Afghanistan two of the last few countries to have polio. Turmoil among the governments and the Taliban’s presence make it challenging to vaccinate children in these areas. In order to succeed in eradicating polio, we need to increase funding available for the Global Polio Eradication Initiative and its member organizations to increase their vaccination capacity. Your donation can make a difference. The end is near! We need to make sure there is not donor fatigue and that current efforts are supported.

Young boys and girls raise their hands to show marks of vaccination against polio, in Afghanistan
Children showing their stamped fingers indicating they have been vaccinated. Source

Polio &Vaccine Bill Brieger | 19 Aug 2019

Recent Surge in Polio Cases in Pakistan Necessitates Urgent Review of Strategy

As part of the course on Social and Behavioral Foundations in Primary Health Care, Muhammad N Asghar posted in the class blog. We have shared these thoughts below.

polio 2Pakistan is one of the three polio endemic countries and recent surge in cases shows that eradication of the disease demands an urgent change in strategy. A look at previous five year cases in Pakistan shows a positive progress in reduction of new polio cases; from 307(2014) to 12(2018), but new cases still appeared in almost every province. The reasons behind this country wide presence of disease can be attributed to internal displacement due to conflicts, weak health systems and operational and resource risks. But the alarming increase in number of new polio cases during 2019 has reversed the whole progress made so far as the number of new cases as of today stands at 53. 32 out of 53 cases are reported from KPK region, which had observed massive internal displacement during last decade but the number of IDPs has decreased from last two years due to stability in the region.

screen-shot-2019-08-18-at-9.26.13-amThis recent surge in polio cases in the the province is mainly due to increase in vaccine refusals due to rumors regarding side effects caused by the vaccine on social media. Official sources reported that after rumors refusals to vaccinate increased by 85% in the province. But high number of cases in other provinces when compared with last year cases indicate that multiple factors are hindering the progress towards containment and eradication of the polio virus disease from the country, which can be attributed to homelessness and poor sanitation, operational issues for vaccine delivery, conflicts, cross border movement etc.

This situation demands urgent review of existing strategy for polio eradication as number of new cases are increasing rapidly. There is a need to work on multiple aspects to make the anti-polio drive successful; some key aspects include detailed geo-mapping of the population at basic level and identification of missed areas to ensure every child is vaccinated, involving community and religious leaders, NGOs, CSOs for confidence building and education of the community, expansion of partnership with nutrition, hygiene, water sectors, and robust rebuttal of rumors and strict action against those involved in such heinous activities etc. There is a new political government of helm, which is sensitive to the social sector issues and taking measures to provide homes, health facilities and education to the disadvantaged sections. International agencies (GPEI, WHO) shall coordinate with the political government to review the existing strategy for revamping it, so that not only the current surge can be contained but the disease can be eradicated from the country to achieve the target of polio free world.

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