- The Washington Times - Sunday, February 27, 2005

Dr. David Heymann, the American physician who is the World Health Organization’s special envoy on polio, was interviewed in Geneva recently by special correspondent John Zarocostas of The Washington Times on efforts to eradicate polio in the three Asian countries where the crippling disease is still endemic.

[Editor’s note: Polio is caused by a virus that sometimes causes serious illness and sometimes doesn’t. Serious cases cause muscular paralysis, and can cripple or kill people by paralyzing the muscles involved in breathing. It used to be common in the United States, where it paralyzed and killed thousands of people every year before a vaccine was developed in 1955 to prevent it.]

Question: Afghanistan, Pakistan and India are the last countries in Asia that still have pockets of polio. Are you hopeful of wiping it out this year?

Answer: Well, with the polio partnership of the United Nations Children’s Fund (UNICEF), Rotary International, the Centers for Disease Control (CDC) in Atlanta and WHO, we’ve been supporting [efforts in] India, Pakistan and Afghanistan, technically and financially, hoping that we can help them interrupt the transmission of polio before the end of this year.



That support comes in technical assistance to countries. It also comes in assistance to social mobilization, which is where UNICEF plays a role, giving them vaccines, and also with Rotary, which frequently fills gaps in activities.

For example, I was at a meeting recently in southern India, where we were planning for ongoing campaigns. Rotary was there, along with UNICEF, and whenever the Health Ministry of the state identified an area where they needed more help — either in providing vehicles, or fuel or some type of material input — Rotary was there, and said, “We’ll support that.”

So, the partners are working very well, and the countries are very dedicated now to [eliminating] polio as well. Polio has become an issue at Cabinet-level meetings in all three of these countries, and they want to interrupt transmission by the end of this year. …

Q: Of the three countries, which has the highest infection rate?

A: Infection has been rampant in localized areas in all of these countries, but especially in India. Right now [the Indian states of] Uttar Pradesh and Bihar are serving as reservoirs [of the polio virus] for India, and in Pakistan, it’s been very hard for them to interrupt transmission of the virus in the lower Punjab province and also in northern Sindh province. So polio remains today in localized areas in these countries and intensive effort is required in these areas.

Q: What about Afghanistan?

A: In Afghanistan, it’s been in the south of the country. But [cases in] Afghanistan [are] intimately linked with Pakistan’s polio because of the porous borders, where people go back and forth. So if polio is interrupted in Pakistan, it will certainly also be interrupted in Afghanistan.

Q: There were cultural problems related with the polio campaigns in [Pakistan’s Northwest Frontier Province]. Has this been overcome?

A: We just recently had a meeting of health ministers and state-level ministers here in Geneva to discuss polio eradication. At that meeting, we were very pleased that the Northwest Frontier Province has not had polio for the last several months now. Activities in that area continue to be healthy, including vaccination campaigns and, more important, the surveillance system to detect polio.

This area of Pakistan is regularly providing information on children with acute flaccid paralysis — which is a sign of polio — and indicators in our surveillance system show that the recording is at a very high level in this part of Pakistan.

Q: What about religious resistance to polio vaccination?

A: Religious resistance to immunization occurs in many parts of the world, due to fears about the vaccine. The fear has been localized, usually; not generalized. In northern Pakistan, those rumors have come and gone, and come and gone. But [immunization] campaigns have been successful, and by adding women to their immunization teams, they have drastically increased the number of children reached by vaccination.

Q: What exactly were the misperceptions of the local population?

A: There were misperceptions that this vaccine could cause infertility in young girls, and sterilize them so that they would not be able to have children when they were older.

Q: What’s the total cost for the worldwide campaign against polio this year?

A: In 2005, the total amount required is $620 million, of which $545 million has either been received or pledged by countries — leaving us a gap of $75 million to fill before the end of the year.

Q: Are you sure you will continue to get funding? This campaign has been going on now for 17 years. Do you think funds will keep flowing?

A: What we recently discussed with our Asian colleagues is that we must finish polio in their countries this year, because the partners in polio eradication who are providing financial resources expect that they will be able to interrupt transmission this year. So, with continued efforts like the immunization campaigns led by Sonia Gandhi in India, by the head of state, Pervez Musharraf, in Pakistan and President Hamid Karzai of Afghanistan, we believe that example will influence people to continue to vaccinate their children.

And in Asia, they have to vaccinate more than three times to get immunity.

In European and North American countries, three doses of that vaccine give solid immunity. In tropical countries, where there are many other viruses in the intestine competing with the polio virus, it takes more doses to provide immunity — sometimes up to six or seven doses, in parts of India.

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