How the end of polio in Africa had positive effects on public health

Polio is a very contagious disease. It is caused by a virus that enters the body through the mouth. The virus then multiplies in the gut and attacks the central nervous system, causing paralysis.

Polio was one of the most feared diseases in the world in the 20th century. Four decades ago, an estimated 350,000 people a year were paralyzed by the poliovirus in more than 125 countries. As a result, the World Health Assembly adopted a resolution in 1988 for the global eradication of polio, which draws inspiration from the eradication of smallpox.

The global program to eradicate polio is led by a number of actors. These include national governments, the World Health Organization (WHO), various development agencies and health workers.

The strategy involves widespread vaccination as part of routine health care services as well as mass vaccination campaigns. Sensitive surveillance to detect and respond to polio cases is also important.

This initiative was extremely successful. The number of polio victims decreased by 99.9% – from 350,000 in 1988 to 175 in 2019. During the same period, the number of polio endemic countries dropped from more than 125 to just two: Afghanistan and Pakistan. A country is endemic when polio is spread.

The newest WHO region to be polio-free certified is Africa. The region is certified on 25 August 2020. The certification took place four years after the last case of poliovirus on the continent.

The polio eradication program in Africa directly combated a serious debilitating disease. But it also provides a platform for broader healthcare services on the continent. Polio eradication has created a new demand for vaccination services and innovative ways to provide health care services.

What is needed to eradicate a disease?

It requires a combination of multiple biological and non-biological factors to eradicate a disease. Only one disease, smallpox, has been eradicated so far.

Polioviruses only survive very short time in the environment and there are no animal or insect reservoirs that carry polioviruses. More importantly, effective vaccines exist against polio. In addition to these biological characteristics of polio, the eradication of polio from Africa required sound leadership.

In 1996, African heads of state decided to expel polio from Africa. Then South African President Nelson Mandela launched the “Kick Polio out of Africa” ​​campaign. Thereafter, societies of the whole society supporting widespread polio vaccination has emerged in African countries. It has involved government departments, the private sector, civil society and the community at large to ensure the extinction of the country polio of the mainland.

Within national governments in Africa, public service departments worked formally and informally across portfolio boundaries to achieve the shared goal of polio eradication. All these efforts 14 years later resulted in the certification of the eradication of polio from Africa.

Certification is based on evidence that something has been achieved. In the case of polio eradication, a region is only certified when all the countries in the area show the absence of poliovirus transmission for at least three consecutive years in the presence of extremely sensitive surveillance.

Polio surveillance refers to a disease detection system that includes community components and laboratory components.

In the community, it is supervised by the general public and health workers. Healthcare workers must report all cases of children experiencing sudden limbs. Community members must report all newly paralyzed children in their communities to health care services. In the laboratory, the poliovirus responsible for any case of polio paralysis is identified and its source determined. Without such high quality surveillance, it would be difficult to determine where and exactly how the poliovirus circulates, or to confirm when it is transmitted. has been eradicated.

Twenty years ago, Africa was close to eradicating polio; dan wrong information surfaced in northern nigeria on the efficacy and safety of polio vaccines. This misinformation led some people in the area to refuse or delay polio vaccines. Vaccination coverage has declined, leading to widespread polio outbreaks in northern Nigeria and beyond. Such misinformation got traction social media.

Reference is made to avoid vaccination, even if it is available vaccine hesitation. Polio vaccine hesitation poses significant risks not only to the hesitant people but also to the wider community. It can prevent African communities from reaching the thresholds for the vaccination needed to keep polio out of Africa. If a single child in any part of the world remains infected with poliovirus, children in all countries are at risk of contracting the disease.

Long Term Rewards

Africa’s health systems are much stronger because of the investments that have been made. Countries have been supported to make life-saving profits. It has increased access to health care in the most remote places, strengthening routine vaccination systems and ensuring strong disease surveillance.

Polio’s legacy must be built to achieve this other important health goals.

Charles Shey Wiysonge, Director, Cochrane South Africa, South African Council for Medical Research


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