POST 01341E: POLIO ERADICATION VS CONTROL—THE REAL COSTS

POST 01341E: POLIO ERADICATION VS CONTROL—THE REAL COSTS FOLLOW-UP ON POST 01339E 25 OCTOBER 2008 ****************************************** There was also myresponse to POST 00931E in which I wrote: QUOTE About the switch from eradication to control, imagine the world asking a mountain climber to climb a mountain that was never conquered before. What do you think our climber will respond, when at a few meters below the top he is requested not only to stop climbing, but to hold on and stay where he is indefinitely. He will rightly answer that he should either reach the top, or go back down, but that there is no way he can stay where he is. The eradication activities took us where we are now, with only 4 endemic countries left. To keep us here indefinitely would require regular supplementary immunization activities in the currently endemic countries, in countries with outbreaks and in countries with low routine coverage. To monitor this all, would require an excellent surveillance system. Unfortunately the reality is, that in the absence of disease, surveillance would soon weaken, and importations in polio free areas would not be detected timely. In other words, the costs for staying where we are would, on a yearly basis, be only little less than the current costs for eradication, but it would eternalise them. It would simply eternalise the agony. If large-scale supplementary immunization would stop, we would face a pandemic in a few years, aggravated by the built up of susceptibles, affecting higher age groups, with higher case fatality. Yemen and Indonesia only gave a pre-taste of what would happen if supplementary immunization stops with polio virus circulating anywhere in the world. To be fully honest, I find the call for switching to control rather ironic and slightly naive, completely missing the point that consolidating the gains without completing the job, is simply not sustainable. It is ethically refutable and operationally impossible. The choice is between achieving the goal or sliding back into the pre-eradication era. UNQUOTE We fully agree that progress has been disappointing for the past few years, but the situation regarding the eradication versus control is still the same. Ironically you could say we have been in a control situation for the past few years with still the same number of countries endemic and some new outbreaks in non-endemic countries. And look at what cost that level of transmission was sustained (controlled). In other words, there are 3 options: 1) The disease is controlled at the current level, with the current costs, but these costs are then eternalized, which to me does not make much sense, economically as well as ethically. Even at the current costs, surveillance would sooner or later fall apart. 2) We decrease dramatically the spending on eradication and expect routine immunization to take care of control. In this option we have to accept that polio incidence will rise to the pre-eradication level, although not quite due to better routine, perhaps 200 000 cases compared to the estimated 350 000 cases before 1988. Of course we would not see all those cases, because surveillance would collapse rapidly. Is that ethically and economically acceptable? Can we tell future polio patients that in 2007 there were only 1315 cases, but the international community decided to stop the initiative? To me that is a non-sense option. 3) We finish the job, using new tools (IPV round in India) and strategies (shorter intervals between monovalent rounds, much faster lab results, allowing for much faster response) and most of all, with renewed government commitment in Nigeria and Pakistan. Nobody, particularly the people actually doing the job, will deny that progress was slow, but control is not an alternative. Although limited, and less visible for those not completely immersed in the programme, there was progress: dramatic decrease of type one virus diversity as well as the number of P1 cases in India and evidence through long-term interruption of indigenous transmission in both states that eradication can be achieved in Uttar Pradesh and Bihar. I recently visited Badaun, a reinfected district in Uttar Pradesh, and spoke with mostly Muslim mothers in the streets. They said they clearly saw the reduction in polio cases over the past years. Health workers do a tremendous and tireless work immunizing each child repeatedly. Should we tell those mothers and health staff that it was all for nothing? I am not trying to play the game of emotional blackmail, but I am trying to confront ‘controllers’ with the consequences of their vision. Last but not least, would the money spent on polio still be available if polio eradication would be stopped. Do the ‘controllers’ really think we actually siphon money potentially from other programmes into polio? It would be much more helpful to come with new suggestions how to finish the job, that to repeat old ideas that miss all ethical and economic foundation. Best regards, Hans Everts ([[email protected]][email protected][/email]) Technical Officer WHO, Geneva -------- Hello, Like with most vertical program eradication is not possible for many reasons. It may be better to integrate by way of increased efforts on Routine immunization through innovative approach, catch up rounds, more participation of private sector, increasing mobilization efforts. The polio virus thrives in the environment in the swamps/ gutters - and there is no programme to eradicate the same, so the source survives. All of human efforts are spent on NIDs SNIDs, during which all other health activities come to stand still such as trainings. I feel now the programme should be converted to control unless environmental clearance is possible Rgds Dr Anil Varhsney ([[email protected]][email protected][/email]) Post generated using Mail2Forum (http://www.mail2forum.com)