The partners in the Global Polio Eradication Program marshalled their forces Tuesday for the launch of a major new fundraising initiative aimed at finally getting the 20-year project over the finish line.
A high-powered launch of Rotary International's $100-million fundraising effort seemed designed both to reinvigorate the spirits of the Rotarians who have raised so far more than US$750 million for the program and to appeal yet again to G8 leaders in advance of their meeting in Toyako, Japan, from July 7 through 9.
While Rotary clubs around the world have pledged to raise another US$100 million over the next three years and the Bill and Melinda Gates Foundation has agreed to match it, the program has a funding gap of over US$400 million for this year and next alone and will need again as much for 2010-12.
Leaders of all four of the partners in the eradication effort - the World Health Organization, Rotary, UNICEF and the U.S. Centers for Disease Control - gathered for the launch, which took place at Rotary's annual international convention in Los Angeles.
"We just would like to encourage them (the G8) to continue to support us to finish the job, in the names of the generations of children that will come," WHO Director General Dr. Margaret Chan said, promising to temporarily reallocate WHO staff to make polio eradication the top operational priority of the Geneva-based agency.
"We cannot afford not to eradicate polio," said CDC director Dr. Julie Gerberding.
"Fundamentally, this is a health imperative. It's an economic imperative for us on a global basis. It's also a moral imperative."
"We who have been given so much have to do our part."
Recently, outgoing Rotary International president Wilf Wilkinson - a Canadian - complained that Canada and other G8 countries were not meeting commitments they'd made at the 2005 leaders' summit in terms of their level of polio eradication funding.
Since then, Canada has promised new funding, announcing last week it would provide $60 million over the next three years to finance efforts to stop polio transmission in Afghanistan. Afghanistan, India, Pakistan and Nigeria are the only countries in the world that have never managed to interrupt polio transmission.
Inspired by the success of the smallpox eradication effort, the polio eradication partners embarked on a mission to permanently end transmission of the virus in 1988. It was originally felt the goal could be reached by the year 2000, but the task proved more difficult than expected. A later goal, for 2005, was also missed.
Mindful of the optics of failure, the partners have been cautious about setting new goals. But equally mindful of the risk of donor fatigue, they had begun to suggest this year might see the end of transmission of Type 1 polio, the most dangerous and difficult to stop of the three strains of polio. (Type 2 polio viruses are believed to have been eradicated already.)
India may be on track to hit that goal, program leaders believe.
But Nigeria remains an unresolved problem. Pockets of resistance to polio vaccine remain in the Muslim north, the lingering legacy of rumours spread several years ago that the vaccine was a western plot to render Muslim children infertile.
Vaccination drives are still missing 30 per cent of children in northern Nigeria, Dr. Bruce Aylward, director of the WHO's polio program, said in an interview.
"Nigeria's not going to meet it," Aylward admitted of the goal of stopping Type 1 polio transmission this year.
He noted continuing spread there threatens other countries in the region. When northern Nigeria halted all polio vaccination in 2003-04, cases spilled over into neighbouring countries, eventually even as far as Indonesia. "That is the big concern, that that could just blow up again," Aylward said.
Recent high-level discussions with Nigerian officials have created optimism in some quarters that there is a political willingness there to tackle the problem head on.
"We are working to make everybody aware of how serious the problem is, how close we are to solving the problem completely," said Dr. Tachi Yamada, president of the Gates Foundation's Global Health Program. "And just the meetings we've had in the last couple of weeks indicate to me that there's real potential for accomplishing what we hope to accomplish in Nigeria."
"I think with all eyes of the world focused on these very last few hot spots, there's tremendous political pressure on these leaders to really focus attention on the problem."
Others remain skeptical that success is as close as program partners believe.
Dr. D.A. Henderson, the U.S. public health veteran who led the smallpox eradication effort, pointed to the fact that there have been nearly three times as many polio cases worldwide so far this year (558) as there were this time last year (199).
"I think what they do (still) have is a good deal of polio," said Henderson, who is with the Center for Biosecurity at the University of Pittsburgh Medical Center. "There's still a long way to go."
"I wish them well. I'm glad they're raising the money. But I think that what is a real problem is that there's an unwillingness to face the issue that if we don't make it, what do we do? And that is something that is clearly up in the air. There is just no policy at this point in time."
