The Global Polio Eradication Initiative (GPEI), the joint effort including Rotary International, the World Health Organization (WHO), the US Centers for Disease Control (CDC), UNICEF and the Bill and Melinda Gates Foundation to eradicate polio, have acknowledged that the “End Game Strategy” scheduled to wrap up in 2018 is about one year behind schedule and will need another $1.5 billion in funding on top of the original budget of $5.5 billion.
The acknowledgement was made officially recently during a briefing on the simultaneous global transition from trivalent to bivalent vaccine. There are three strains of polio. The primary tool in fighting polio has been the Sabin trivalent oral vaccine using weakened forms of all three viruses. A global switch across 155 countries still using the trivalent vaccine will occur beginning on April 17 and will wrap up on May 1. The trivalent vaccine will not be used anywhere in the world thereafter.
The switch is possible because there is no type 2 wild polio virus left. The last recorded case occurred in 1999. The switch is expected to have a positive impact on the final stages of the effort because bivalent vaccine is actually more potent than the trivalent–for the two forms of the disease it is created to fight. The bivalent vaccine was credited with allowing India to eradicate polio officially in 2014, three years after the last case was reported there in January 2011.
The switch must be made simultaneously around the globe because a few of the children receiving the oral vaccine will actually infect other children with the disease. This form of the disease is called circulating vaccine-derived polio virus (cVDPV) and while less virulent, the paralytic effects can be the same. It is important to stop giving the vaccine universally so that a child can’t infect a neighbor who hasn’t received the type 2 vaccine.
Stephen Cochi, Senior Advisor to the Director of the Global Immunization Division at the CDC, noted that the GPEI anticipates one breakout of type 2 cvdpv resulting from the switch and has 100 million monovalent type 2 vaccine doses ready to combat it if it in fact occurs.
The CDC joined Rotary in 1988 to launch the Polio Plus program to eradicate polio. The initial estimate was that transmission of the virus could be suspended by 2000. We are now 16 years past that date, but now appear to be on the cusp of suspending transmission.
The disease is circulating only in Pakistan with some cases occurring across the boarder in Afghanistan. Only ten cases of the wild polio virus have been identified so far this year; another three cases of cVDPV has also been documented this year. At this point last year, there had been 22 wild cases and just one cVDPV case.
It is important to put these numbers into a longer term context. In the mid 1980s when this global effort was being organized, there were up to 400,000 cases per year, meaning that the annual number of cases has been reduced by 99.98 percent.
The transition from trivalent vaccine to bivalent vaccine will be accompanied by placing greater emphasis on the use of the Salk IPV vaccine, using killed viruses in routine immunizations around the world. The Salk vaccine must be injected and therefore is more difficult to administer in mass programs as the OPV is used in the developing world. The IPV does not have any risk of infecting children so it is and will continue to be administered in its trivalent form as a barrier against outbreaks of cVDPV.
The GPEI expects that polio transmission will be suspended during the traditional low season this year, which ends about this time each year. Next month, I will be visiting Pakistan to report on the eradication of polio from ground zero. It is important to note that the GPEI expects to observe the last case of wild polio virus in history in the next few weeks.
Rotary International has provided leadership in fundraising and otherwise supporting the GPEI’s work and has provided over $1.5 billion over the life of the effort to date, coincidentally comparable to the funding requirement anticipated for the revised final year of the End Game Strategy.
Carol Pandak, Director of Polio Plus at Rotary International, notes, “Rotary is committed to supporting polio eradication until we achieve our goal of eradication.”
“Rotary is committed to raising US$35 million per year through 2018, to ensure we fully leverage our fundraising agreement with the Bill & Melinda Gates Foundation by which every dollar Rotary commits up to U$$35 million per year is matched 2:1.,” she continued. “However, that money is only the tip of the iceberg. Rotary members will also continue to play a key role advocating in countries around the world, encouraging their governments to support the final push to end polio.”
The Bill and Melinda Gates Foundation has been matching Rotary money on the basis of $2 for each dollar from Rotary. Pandak adds, “Rotary and the Bill & Melinda Gates Foundation are both dedicated to ending polio and enjoy a strong partnership. We’re in the third year of a five year fundraising agreement and we are focused on maxing out the potential match from the Gates Foundation for each year of the agreement.”
“Based on the our long-term fundraising partnership with the Gates Foundation, we have agreed to monitor the funding situation and continue a dialogue if there are funding needs past 2018,” she concludes.
Michel Zaffran with the WHO says that they have already begun reaching out to the funding organizations, presumably including Rotary and the Gates Foundation, to ensure that the effort can be maintained through 2019 as required.
This is the first official acknowledgement I’ve seen that the original End Game Strategy will have to be modified in order to finish the job. The estimate of $1.5 billion represents a significant challenge for the world and will require individuals, nonprofits, NGOs and governments all to collaborate on this funding need over the next three years to ensure that three decades of work aren’t wiped out by a rogue strain of the vaccine.
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