Should we eradicate poliomyelitis?

Poliomyelitis is a severe condition which had devastating impact no more than a few decades ago all over the world, leaving sequelae such as paralysis which still reminds us a virus which is close now to be eradicated from the Earth. There are only three countries in the World (Nigeria, Pakistan, Afghanistan) where poliomyelitis is still circulating today, although there are alarming signals coming from Syria which may complexify the current status of polio eradication. Fighting the virus has been made difficult by its long lasting remnence in wet environment. However, one has never been such as a tipping point with regard with complete polio eradication. “Only” 296 cases have been reported to WHO worldwide since the begining of 2013 (may be plus 20 additional cases from Syria if soon confirmed), 99 of them coming for the three endemic countries. International commitment have been agreed on to end definitely circulation of polioviruses, following the heroic era of smallpox eradication. A lesson which comes from the community of experts in communicable diseases is, that when its has a goal such as eradication, it succeeds to raise substantial funding, here 4 billion euros will be dedicated up to 2018 to achieve it. More than a third of this amount comes from the Bill and Melinda Gates Foundation.

One could have imagine that the whole international community would have back on such a commendable goal. Let’s eradicate polio and afterwhat go and tackle other priorities, which are so many in the field of global health. But that is not the case. The famous NGO Médecins Sans Frontières at the occasion of the World Day on Polio “denounces eradication at any cost” (read the paper from Afsané Sabouhi, in the French speaking website of Nouvel Observateur). It was well known that the polio campaign met resistances and known serious troubles in the field, since more that 30 vaccine officers had been shooted and killed up to date, in Pakistan and Nigeria. One did not assume however to what extent NGO and field organisations were doubting and reconsidering the objectives and means dedicated towards polio eradication.   What is of concern is that these organisations are those who have probably the closest and deepest understanding and knowledge about local perceptions. What is sure too, is that they have their heads down, sometimes far from the big picture. So what should we thing about?

The last warriors against polio seem to be exhausted. For example,  Claire Magone, who is a research director at the Centre de réflexion sur l’action et les savoirs humanitaires at MSF summarized her round table on the topic:« It seems to be an endless war against polio. We want you to listen an other perspective, where we need to consider also human costs, with its social and economic burden before keeping such a stubborn  approach aiming to absolute eradication of polio ».

What MSF says is that these very last areas which are asked to push this eradication program are those which are lacking the most essential health care needs. Facing to that, huge resources are invested on an invisible ennemy causing such a few number of remaining cases, when no effort are dedicated to most visible problems expressed from local populations. These unbalanced efforts seem hard to understand and somewhat indecent to these vulnerable populations. That leads to trigger rumours and sometimes violence. By definition at the dawn of eradication, enemy is almost invisible. Elisha Renne, an American anthropologist who visited women in villages of Nigeria reported:« Their children die from measles or malaria, they hardly have access to water and sanitation. How can they perceive the stubbornness of health authorities to have their children vacccinated against polio? Even these vaccines delivered for free are source of defiance in a country where deaths have been reported in the past during clinical trials conducted by pharmaceutical companies ». Armed groups did see in these international driven campaigns the Western hegemony considered as a threat to their local cultures and populations, and they often target their attacks on local vaccine officers.  In this difficult context, health professionnals often need now to be protected just to do their job.

How Dr Hamid Jafari, director of the eradication program at WHO did react to these doubts and questions raised by MSF ?« Should we give up? But these violent groups will find other targets thereafter. Will we have next to give up when fighting for women’s rights, for similar reasons? I cannot believe that. Come back is not an option here. We have to achieve our endgame goal.».

And now, how can we listen to these heroic and exhausted fighters against polio, who, from the field, are raising doubts on the current approach, without geopardizing the ultimate goal of total eradication of polio from our world, as WHO bravely, legitimly and stubbornly recommend it?   Isn’t it time now to ask for an additional international effort, for funding other essential public health needs these concerned population are clearly facing, even for helping achieving the ultimate goal for polio eradication?

Yes, definitely, we want to eradicate polio, and that needs to be claimed particularly this World Day of Polio, Oct 25, 2013. However, we should probably, for the great benefit of polio eradication, listen to these NGOs which from the field raise today some doubt and concern on the current approach which is run by the international community under (the needed) WHO coordination. An heavy infrastructure has been deployed in part of the world: it may benefit more broadly to their health tremendous needs. For additional and probably modest overcost, these populations which participate to the good of our whole humanity by contributing to eradicating polio from the Earth, could benefit of a supplement of our empathy and generousness to improve their other primary health needs. We cannot postpone today our efforts against polio, since any delay would lead to reemergence of devastating epidemics very soon, and Syria sends an alarming signal of such a risk today, so let’s put all our chances for succeeding polio eradication by a better understanding of needs from the field.

(Crédits photo : Islamabad, Pakistan, avril 2013, Muhammed Muheisen/AP/SIPA, via pourquoi-docteur.nouvelobs.com)

 

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