Polio Could Be Gone by 2004, Agencies Say

UNITED NATIONS -- Polio, which only decades ago killed thousands and crippled millions, could finally be eradicated--everywhere, forever--by the end of next year, say the leaders of a global campaign against the infectious disease.

All that is required is the continuing collaboration of some of the world’s poorest and most turbulent countries--plus $275 million in long-requested funding that U.N. agencies need to reach the remaining unvaccinated children.

“Eliminating polio within the next 18 to 20 months is definitely feasible, depending on whether we are able to get all the funds we need and all the political and civil cooperation we need,” said Bob Keegan, deputy director of the global immunization division of the Centers for Disease Control and Prevention in Atlanta, which is providing technical assistance to the U.N.-managed campaign.

When the U.N.-affiliated World Health Organization and the United Nations Children’s Fund launched their joint anti-polio drive in 1988, an estimated 350,000 children in 125 countries were newly paralyzed from the disease. Then, after spending billions of dollars vaccinating billions of children around the world, health agencies were able to identify just 480 fresh cases in 2001, all of them in the 10 nations where the U.N. is now concentrating its eradication efforts.

“This is an extraordinary achievement already, when you think of the millions of cases averted and the hundreds of lives saved,” Keegan said.

Civil wars, sprawling shantytowns and competing health emergencies have kept polio alive in impoverished communities throughout South Asia and Africa. But at 9 cents a dose, the oral polio vaccine may be the greatest public health bargain of all time. U.N. workers say they can get it to children in all these places, from the refugee camps of Afghanistan to the satellite slums of Lagos, Nigeria.

“These are all tough areas, with dense populations and lots of other problems,” said Dr. Ciro de Quadros, a WHO polio specialist who is credited with cleansing Latin America of the disease. “But by vaccinating and re-vaccinating, we are getting rid of it. We are very near the end, but the last leg of a race is the most difficult.”

Still, De Quadros says he is confident that the funds will be found and the campaign will achieve its goal. “By the end of 2003,” he said, “polio should be eliminated completely.”

Like smallpox before it, medical experts say, polio may soon survive only as sample cultures in a few research laboratories.

“When you are out there seeing the end of a disease, you feel that you are participating in history,” said Sebastia~o Salgado, a prizewinning Brazilian photojournalist who spent much of last year visiting polio clinics and vaccination brigades in Africa and South Asia.

Salgado’s photos starkly document the work that remains to be done.

On a muddy bend of the Congo, bare-chested health workers with bullhorns stop every passing boat--every ferry, every dugout canoe--to give children their mandatory two droplets of vaccine.

In southern India, a packed third-class passenger train is halted between stations as doctors clamber aboard with vaccination kits, distributing doses on the spot. In Sudan, two volunteers, resplendent in crisp white “Just Two Drops” T-shirts, tote a cooler of vaccine to a village a day’s walk across the baking plains.

The photographs also chronicle the human devastation of the disease: a clutch of pleat-skirted New Delhi schoolgirls, giggling and vibrant in every respect except the withered legs encased in their metal braces; Mohammed, a disabled Somalian nomad left behind by penniless parents; paralyzed Congolese teenagers with makeshift wooden crutches and wheelchair contraptions fashioned from bicycle parts.

There is still no cure for polio, and paralysis can follow infection in a few hours. Yet just four doses of vaccine during childhood will protect against polio for life, and systematic vaccination can rid a region of the disease permanently.

Salgado took on the assignment at his own expense after being approached by U.N. officials who were trying to publicize their underfunded campaign. His first reaction to their request, he said in an interview at a New York gallery that is showing the photographs, “was surprise--I said, there is still polio around the world?”

In Brazil, like almost everywhere else in the Americas, polio was wiped out decades ago. The last documented outbreak in the Western Hemisphere was in an isolated town in the Peruvian Andes in 1991; the Shining Path guerrillas, who controlled the area, clandestinely aided a door-to-door vaccination drive, De Quadros said.

The United States, where the global fight against polio began in earnest half a century ago with the “March of Dimes” and public inoculation drives, has been free of the disease since 1979, when vaccinations short-circuited an outbreak in a Pennsylvania Amish community that had previously rejected immunization.

What most motivated Salgado, he said, was the contrast between the polio campaign and his previous work, which focused on the relentlessly harsh lives of indentured workers and refugees from wars and famines. “Those are things that seem in some way to never change,” he said. “I was eager to work on a story where you see the end of the story.”

Proceeds from the sales of Salgado’s photos will go to the polio fund, as will money from UNICEF’s annual Halloween collections and individual donations raised through a new campaign Web site that went online Thursday (www.endofpolio.org).

The United States, Japan and several European governments recently increased donations to the U.N. Global Polio Eradication Initiative, as have the Rotary International clubs that are by far its biggest source of private support, giving $462 million to date. But the vaccination campaign still needs $80 million this year alone to reach all its targeted communities, officials say.

The next target for the WHO and UNICEF is measles, which kills a million children each year in the world’s most impoverished countries. As with polio, massive vaccination campaigns could virtually eliminate these fatalities. The U.N. agencies say that by stamping out polio, they hope to be able to convince impoverished countries and foreign donors to mobilize the resources needed to control measles and other infectious diseases.

“Our first goal is the eradication of polio,” De Quadros said. “If we fail in this, we will never be able to do anything else.”