The End Of Polio Is Within Reach. Here’s What Workers Are Doing To Finish The Fight.

Part 2 of our "World Immunization Week" series

April 24-30 is World Immunization Week, and we at A Plus are proud to present a five-part series that celebrates the incredible impact vaccines have had on global health.

Polio is a viral disease that used to affect hundreds of thousands of people every single year. So far in 2016, there have only been 11 cases of polio in the entire world. This dramatic decrease is due to vaccination. And thanks to the dedicated efforts of health organizations around the world, eradication of polio is now within reach. 

Common effects of polio are flu-like symptoms that include fever, body aches, and nausea. In severe cases, polio attacks nerves in the body and causes paralysis. If this paralysis affects the nerves associated with the respiratory system, it can be fatal. Even mild cases of polio can have long-term effects. Post-polio syndrome, as it's known, can cause increased muscle pain, muscle atrophy, and chronic fatigue.

Though Jonas Salk's polio vaccine was introduced in 1955 and began to significantly decrease the number of polio cases in the United States, it was still a global problem for decades to come, spurring the formation of an international partnership to end the scourge of polio once and for all. 

Rotary International first began administering the polio vaccine for local coverage campaigns in 1979 but changed the game in 1985 with the formation of the PolioPlus program, with the mission to eradicate polio from the face of the planet. 

Rotary championed partnerships with United Nations Children's Fund (UNICEF), Centers for Disease Control and Prevention (CDC), and World Health Organization (WHO) to form the Global Polio Eradication Initiative (GPEI) in 1988 when polio was endemic in 125 countries. 

Through their extensive campaign to bring vaccines to children all over the world, polio has been eradicated in 123 of those countries, with only Pakistan and Afghanistan remaining. 

Reduction in countries with endemic polio since 
Reduction in countries with endemic polio since  Michael Schall / A Plus

"In 1988 when the World Health Assembly adopted the resolution to eradicate polio there were some 350,000 cases of polio every year and last year there were 74 cases of polio globally, so that's tremendous progress since that time,"  Carol Pandak explained to A Plus. Pandak has been the Director of Rotary's PolioPlus program for the last 15 years. 

Rotary's work to eradicate polio is being accomplished through the use of two main types of vaccines: the inactivated polio vaccine (IPV) and the oral polio vaccine (OPV), each with their own advantages and disadvantages. 

The IPV is an injected vaccine that uses a dead form of the virus. It is administered by a trained medical professional (typically during a routine vaccination visit) and it protects against polio in the blood and respiratory tract. Essentially, it's used for maintenance in the United States and other countries that do not have regular exposure to the wild poliovirus.

The ingested OPV, on the other hand, also provides protection in the intestinal tract which makes it more useful at stopping the transmission of polio where the wild virus still poses a threat. Because the OPV is simply given with two drops in the mouth, there are more people capable of administering the vaccine. This makes it easier for large campaigns, like the ones being performed by Rotary.

"The downside of the oral vaccine is that it's not effective in just a single dose, you need multiple doses," Steve Wassalik, a medical epidemiologist with the CDC, told A Plus. 

There are a number of challenges to finishing the eradication effort in these countries. In order to keep volunteers safe while giving vaccines, there is cooperation with local religious leaders, the Red Cross, and Red Crescent who work with locals and negotiate peace. 

"There are some far-flung communities, really remote communities that sometimes aren't on the map and we have to find ways to identify them and ensure that they're getting onto these [immunization coverage] plans so we reach them not just once, but multiple times with the vaccine," Pandak said.

Not only does conflict make it unsafe for workers to visit some areas, it also makes it hard to find everyone. As people flee dangerous areas, Rotary has set up immunization posts in order to catch people on their way out of cities. 

Additionally, the lack of infrastructure in some regions makes it difficult to reach every child the multiple times that are required to give the four doses needed to fully immunize the children. Despite these obstacles, these organizations have made tremendous progress and are continuing to work hard to protect every single child on the planet.

Young girl in Pakistan receiving the oral polio vaccine (OPV) 
Young girl in Pakistan receiving the oral polio vaccine (OPV)  Asianet-Pakistan /

Though the end of polio may be within reach, Pandak cautioned that it is critical to keep vaccination rates high in order to see the mission through.

"If there's polio anywhere in the world it's a threat to children everywhere because we live in such a small world," Pandak warned. "People are traveling all the time. I do think that low immunization rates pose a threat and [vaccination] is something we [at Rotary] try to promote whether it's in Pakistan, India, or the United States."

There will be a day where nobody else falls ill from polio, and that day may be here sooner than we think. The last case of polio is expected to happen either this year or early in 2017. Health care workers will diligently monitor for any new cases. Once three years have passed with no new cases, the world can be certified as polio-free.

Even after certification comes, the vaccine will still continue to be administered for an undetermined amount of time. Ultimately, Wassalik said, the price of the vaccine will likely play a role in how long individual countries continue to vaccinate, though he believes the IPV may be given indefinitely in some areas.

Because polio is so close to eradication, many are wondering which childhood illness is set to be eradicated next. There isn't a clear consensus yet, but malaria or measles could be the new focus. While health care organizations will be able to use a lot of information gained during the polio eradication campaign, the new disease will be targeted as part of an increased push toward higher rates of routine vaccination.

Want to learn more about how Rotary and its partners are bringing an end to polio? 

Check out "The Agents of Polio Eradication" here:

Join the Agents of Polio Eradication by donating to Rotary International here. For every dollar that comes in, the Bill & Melinda Gates Foundation will donate $2, which triples the power of the contribution.

Check out our entire World Immunization Week series:

Part 1: Vaccines 101: Everything You Need To Know About Our Greatest Medical Marvel

Part 2: The End Of Polio Is Within Reach. Here's What Workers Are Doing To Finish The Fight.