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Despite the pointless political assassinations of vaccine workers or the police officers who guard them in a few deeply troubled areas, enough progress has been made against polio in the past year that health experts are now planning for the grand finale—its complete eradication by 2018. The official to-do list of what needs to be done and when to obliterate the crippling childhood disease—which goes by the name Polio Eradication and Endgame Strategic Plan 2013–2018 (pdf)—will be formally presented at an international health meeting in Abu Dhabi on April 25.
"2012 was a very important year for the polio program,” says Hamid Jafari, who directs the World Health Organization’s Global Polio Eradication Initiative. Speaking by telephone in April to group of journalists gathered in New York City to learn about the proposed plan, Jafari said, “We had the fewest number of cases in the fewest countries in the fewest number of districts.”
There is room for cautious optimism. Worldwide, the number of laboratory-confirmed cases of paralytic polio caused by the so-called wild type virus dropped to 223 in 2012—the lowest it has ever been. Just five years ago there were 1,651 cases worldwide, and 20 years before that, in 1988, there were an estimated 350,000 cases. As of April 10 this year there have been 18 naturally occurring cases of polio in the world—eleven in Nigeria, six in Pakistan and one in Afghanistan. (The majority of polio cases in any given year occur in summer and fall.)
The real stunner of 2012, however, was the successful eradiation of polio from India, which accounted for the majority of polio cases worldwide just seven years ago (in 2006).
For years public health experts worried privately whether it was even technically feasible to wipe out polio in such a large, geographically and socioeconomically diverse country. But working with local and international partners, India spent $1.5 billion on the problem and engaged thousands of people from local communities in its anti-polio vaccination and education campaigns. "Polio eradication in India eradicated the excuse of saying it's too hard to reach [hard-to-reach] groups," Apoorva Mallya of the Bill and Melinda Gates Foundation said at the April journalists’ briefing.
At a cost of $5.5 billion beyond what has already been raised, the proposed global eradication plan is by no means inexpensive. One of the great ironies of any disease elimination program (of which polio would be just the third example, after smallpox in humans and rinderpest in cattle) is that the costs to prevent the last several dozen cases are quite high compared with the previous hundreds of thousands. The extra complexity of including the hardest-to-reach people and places adds significantly to the price. But most health experts and certainly billions of parents around the world see polio eradication as a good investment that yields priceless benefits in terms of lives saved and the prevention of lifetime paralysis.
Successfully wiping out polio is by not, however, a foregone conclusion. All the world’s governments—working through the World Health Assembly—had previously set 2000 as the target year for polio eradication. But five years later it was clear the effort had fallen short: annual polio numbers were stuck between about 1,000 and 2,000 cases globally. Financial shortfalls and social upheaval played significant roles in missing that earlier deadline.