Polio eradication is achievable by 2018 and urgent, declare 400+ global scientists

Experts from 80 countries cite time-limited opportunity, endorse comprehensive new eradication strategy

Hundreds of scientists, doctors and other experts from around the world launched the Scientific Declaration on Polio Eradication today, declaring that an end to the paralyzing disease is achievable and endorsing a comprehensive new strategy to secure a lasting polio-free world by 2018. The declaration's launch coincides with the 58th anniversary of the announcement of Jonas Salk's revolutionary vaccine.

 

The more than 400 signatories to the declaration urged governments, international organizations and civil society to do their part to seize the historic opportunity to end polio and protect the world's most vulnerable children and future generations from this debilitating but preventable disease. The declaration calls for full funding and implementation of the Polio Eradication and Endgame Strategic Plan 2013-2018, developed by the Global Polio Eradication Initiative (GPEI). With polio cases at an all-time low and the disease remaining endemic in just three countries, the GPEI estimates that ending the disease entirely by 2018 can be achieved for a cost of approximately $5.5 billion.

 

"We have the tools we need and a time-limited opening to defeat polio. The GPEI plan is the comprehensive roadmap that, if followed, will get us there," said Dr. Walter Orenstein, professor and associate director of the Emory Vaccine Center at Emory University and former director of the U.S. Centers for Disease Control and Prevention's National Immunization Program. Dr. Orenstein is one of the scientists spearheading the declaration and among the signatories who were on the frontlines of ending smallpox, the only human disease to be successfully eradicated.

 

The declaration – housed online by Emory University at vaccines.emory.edu/poliodeclaration – notes that polio vaccines have already protected hundreds of millions of children from the disease and eliminated one of the three types of wild poliovirus, proving that eradication is scientifically feasible. It calls on the international community to meet the goals in the GPEI plan for delivering polio vaccines to more children at risk, particularly in Afghanistan, Nigeria and Pakistan, where polio remains endemic and emergency action plans launched over the past year have resulted in significant improvements in vaccine coverage.

 

"Securing a lasting polio-free world goes hand in hand with strengthening routine immunization. We need all countries to prioritize investments in routine immunization," said Dr. Zulfiqar Bhutta, founding director of the Center of Excellence in Women and Child Health at Aga Khan University. Dr. Bhutta, one of the declaration's leaders, is a member of the Strategic Advisory Group of Experts (SAGE) on Immunization, a technical advisory body to the GPEI.

 

The declaration emphasizes that achieving polio eradication requires efforts interrelated with strengthening routine immunization, a new focus of the GPEI plan. As the last cases of polio are contained, high levels of routine immunization will be critical. At the same time, resources and learning from polio eradication efforts can be used to strengthen coverage of other life-saving vaccines, including for children who have never been reached with any health interventions before.

 

The scientists and experts signing the declaration called on the international community to take steps outlined in the GPEI plan to address challenges that have posed obstacles to polio eradication in the past, including improving immunization campaign quality to reach missed children and eliminating rare polio cases originated by the oral polio vaccine. While previous polio efforts have sought to interrupt wild virus transmission and then address vaccine-derived virus, the new GPEI plan addresses both simultaneously with a timetable to phase out use of oral polio vaccines and introduce inactivated polio vaccines. The declaration urges vaccine manufacturers to provide an affordable supply of the different vaccines required for eradication, and calls on scientists to continue researching new and better tools.

 

"As long as it exists anywhere in the world, polio threatens children everywhere," said Professor Helen Rees, executive director of the Wits Reproductive Health and HIV Institute at the University of the Witwatersrand in South Africa, who signed the declaration and chairs SAGE. "By pursuing in parallel all of the steps needed to reach eradication, including the introduction of inactivated vaccines, countries have a complete path to eliminate polio's threat." In November 2012, SAGE recommended the introduction of at least one dose of inactivated polio vaccine into all routine immunization programs prior to the phase-out of oral polio vaccines.

 

In light of recent attacks on health workers in some endemic countries, the declaration stresses the need to protect polio vaccination teams as they do their work. The GPEI plan includes a series of risk-mitigation strategies for insecure areas, including deepening engagement with community and religious leaders.

 

The scientists and experts signing the declaration hail from 80 countries and include Nobel laureates, vaccine and infectious disease experts, public health school deans, pediatricians and other health authorities. More than 40 leading universities and schools of public health and medicine are promoting the declaration on their websites, including Aga Khan University, the Harvard School of Public Health, the London School of Hygiene & Tropical Medicine, Al Azhar University (Egypt), University of Cape Town, Redeemer's University (Nigeria) and Christian Medical College Vellore (India).

 

The declaration notes that the world has a unique window of opportunity to eradicate polio. Only 223 new cases due to wild poliovirus were recorded in 2012, an historic low and a more than 99 percent decrease from the estimated 350,000 cases in 1988. Just 16 new cases have been reported so far in 2013 (as of 9 April). India, long-regarded as the most difficult place to eliminate polio, has not recorded a case in more than two years.

 

"Eradicating polio is no longer a question of technical or scientific feasibility. Rather, getting the most effective vaccines to children at risk requires stronger political and societal commitment," said Dr. David Heymann, head and senior fellow at the Chatham House Centre on Global Health Security and a signatory of the declaration. "Eliminating the last one percent of polio cases is an immense challenge, as is the eradication endgame after that. But by working together we can make history and leave the legacy of a polio-free world for future generations."

(Source   EurelekAlert-Public- release-13  April 2013/Global Health Strategies)

 

Foussénou    Sissoko

Health   Communication  Expert

sissokofouss@yahoo.fr

Prevention of DR-TB.......a fantasy

Prevention of DR-TB – I am yet to understand if there is any such agenda  in TB program or it is just a fantasizing imagination? The amount of efforts we put in creating hue and cry over DR-TB, probably we don’t even invest 10% of that energy and emotion to advocate for DR-TB prevention.

Does it mean DR-TB is an unpreventable illness?

There is no scientific evidence that said so. DR-TB is preventable. It is said to be a man-made phenomena and requires quality implementation and monitoring of the basic activities that can ensure drug adherence and timely treatment completion by the TB patients enrolled in the national program.

In public health programs 'basic' interventions often bypass due attention of the managers and activists.

A notable example is patient-provider meetings. These meetings were introduced into national TB control initiative as the key platform of TB patients’ education and treatment compliance that can further lead to effective community-facility collaboration.

Can anyone of this forum share the experiences of a patient-provider meeting? How the quality of such meetings is being ensured? What outputs and outcomes are expected from these meetings? What indicators are being used to monitor these activities? Any relevant case study showing expected results?

I believe I am asking for too much.

Sometimes I feel we are just inviting DR-TB to perish us.

Exactly the way, HIV was combated with poorly organized prevention strategies and tools, especially in Sub-Saharan Africa, decades ago.

   

We already saw the result of that.

Extra-couple sex is key HIV transmission factor in Africa

News From Foussénou  Sissoko
Health Communication Expert

  Extra-couple HIV transmission — infections from sexual intercourse taking place outside an established partnership — continue to fuel new HIV infections among heterosexual couples in Sub-Saharan Africa, according to a study.

In some countries, up to 65 per cent of new infections among men in co-habiting relationships are due to extra-couple intercourse. 

SPEED READ

·         Study analyses HIV tests of 27,000 cohabiting couples in Sub-Saharan Africa

·         Up to 65 per cent of men contract HIV through extra-couple intercourse

·         Study recommends HIV interventions for all sexually active people, not just 'at risk' groups

Scientists analysed the HIV tests of 27,000 cohabiting couples from 18 African countries. They found extra-couple transmissions to be a common contributing factor for new HIV infections in the region and that the transmissions within couples occur largely from men to women.

For this reason, the authors advocate HIV prevention interventions for the entire sexually active population, not just couples where one partner is HIV-positive.

Sub-Saharan Africa is home to around 22.9 million people living with HIV/AIDS — the majority of the 34 million infected people worldwide — and registers the highest number of HIV-related deaths annually, according to the WHO.

Steve Bellan, a post-doctoral researcher at the University of Texas and the study's lead author, tells SciDev.Net that the research team wanted to identify how many people were infected with HIV before entering their current relationship; how many were infected by their official partner; and how many by extra-couple intercourse.

"Extra-couple transmission within stable, cohabiting couples was responsible for new HIV infections among an overwhelming 32-65 per cent of men and 10-47 per cent of women — varying according to country," Bellan says.

He says that individual country analyses gave wide-ranging results relating to the percentage of transmissions due to extra-couple intercourse.

Bellan was unable to say if the study's findings were typical of Africa only, but he called for further research to enable a comparison of world regions.

The study, published online in The Lanceton 5 February, proposes certain measures to help curb the epidemic, such as early and proper antiretroviral treatments.

Couples should also be offered the opportunity to get tested, receive their results and mutually disclose their status in a supportive counselling environment, the study says, as this will aid treatment and prevention.

It also recommends expanding treatment, whereby all infected individuals should be given immediate early treatment on a 'test and treat concept' basis.

Alloys Orago, director of Kenya's National AIDS Control Council, tells SciDev.Net: "Since 2008, we have been advocating for a reduction in the number of sexual partners and being faithful to a single, uninfected sexual partner as a tool in HIV prevention".

"HIV prevention should target everybody, not just populations perceived to be most at risk, because HIV knows no boundaries," he concludes. 

  Link to study abstract in The Lancet

(Source  : SciDev.Net's Sub-Saharan Africa desk.)