The Polio Endgame | Health Policy and Reform

Perspective
The Polio EndgameNEJM | June 15, 2011 | Topics: International, Public Health
Bruce Aylward, M.D., and Tadataka Yamada, M.D.

Infection with poliovirus can have devastating consequences, including paralysis and death. In 1988, a year when an estimated 350,000 or more children were paralyzed by polio, the World Health Assembly initiated a global effort to eradicate the infection once and for all. It was an audacious undertaking, given that the virus circulates largely undetected, requires laborious cell-culture techniques to confirm infection, and is tackled with vaccines that provide imperfect protection in the gut.

Initially, the number of polio cases and countries with infections fell rapidly, particularly as financing and political support increased in the mid-1990s. The last case of paralytic poliomyelitis caused by the serotype 2 wild poliovirus was detected in 1999. The number of new polio cases caused by the two remaining wild serotypes had decreased by 99% between 1988 and 2005, but progress had stalled and there was a danger of failure when wild polio viruses were reintroduced into large areas of Africa and Asia. By the end of 2009, sustained investments in innovation had produced a new bivalent oral poliovirus vaccine (OPV)1 and novel tactics for reaching children who had been missed consistently by vaccination campaigns. A new independent monitoring process was established for overseeing the program and guiding course corrections. Since January 2010, new polio cases have decreased by 95% in the world’s largest remaining reservoirs of indigenous virus in northern India and northern Nigeria; the number of cases caused by serotype 3 has fallen by 92% globally; and most countries where poliovirus had been reintroduced have again become polio-free (see map and interactive map).

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The Polio Endgame | Health Policy and Reform