In the United States, an immunization engine revs into life the instant an infant wails in the birthing room: over the next many years, the newborn is wheeled in for well-baby checks, cajoled into painful pit-stops at the vaccination nurse’s office (where he’s consoled with stickers) and monitored until (and beyond) his enrollment into kindergarten at the age of six. By the time he begins school, the child’s immune system is built to resist debilitating viruses like polio.
Consider now the birth of a baby in a remote village in India. Here, the parents of a newborn don’t know about the recommendations of the American Academy of Pediatrics. They are unaware that all newborns must receive four doses of Inactivated Poliovirus (IPV) at two months, then at four months, then between six and 18 months and, finally between four and six years of age. Dictates like these mean little in a place where, more often than not, daily survival is a luxury.
An ambitious initiative by Rotary International’s program called PolioPlus, in conjunction with the Gates Foundation, intends to make polio vaccination a priority in India, especially in states like Uttar Pradesh and Bihar where polio is endemic. “For Rotary International, this is the final big push to eradicate polio from the world,” says Rotarian Mahesh Nihalani of Cupertino, Calif.
This July, the Rotary Foundation received a $100-million grant—the largest grant ever received by Rotary in its 102-year history—from the Bill and Melinda Gates Foundation. The $100-million grant came with the challenge that Rotary should raise funds to match the grant, dollar for dollar, over the next three years. Rotary has now committed to raising the $100 million in new funds, and Rotarians around the world are brainstorming as to how to realize this intimidating goal.
At the Quinlan Community Center in Cupertino, a core team of the local Rotary meets many times a week to figure out the practical ways to publicize a fundraising effort. They are hoping to drum up interest in a concert titled “Ehsaas Hai?”(“Do You Feel”?) by renowned flautist Pandit Hariprasad Chaurasia and the Bay Area’s famous sitarist, Pandit Habib Khan, on October 11th at Cupertino’s Flint Center. Organizer Tina Ferguson says the goal is to raise $100,000. “Since India is one of the important polio-endemic targets,” Ferguson says, “[we wanted to] reach out to the local Indian community.” Two other major fundraising concerts will be planned by the local Rotary over the course of the next three years to meet the challenge from the Gates Foundation.
Polio eradication has been Rotary’s top priority since 1985; to date, it has contributed $633 million toward the eradication effort. In the next year, this Evanston-based volunteer service organization will spend the initial $100 million in direct support of immunization activities carried out by the Global Polio Eradication Initiative (GPEI), a partnership spearheaded by the World Health Organization (WHO), Rotary International, the U.S. Centers for Disease Control and Prevention, and UNICEF.
Old Disease, New Outbreaks
Polio was one of the most dreaded childhood diseases of the early 20th century around the world. Polio epidemics crippled thousands of people, mostly young children, each year. In the 1930s and ’40s, parents were terrified that polio would leave their children unable to walk or force them to spend the rest of their lives in an iron lung.
The polio virus enters the body through the mouth and multiplies in the intestine, attacking the nerve cells of the spinal cord, destroying neurons, and killing muscle function altogether. Unlike smallpox, which had visible signs, polio infections are hard to identify. “For every person who is paralyzed, between 200 and 1000 infected people come down with little more than a stomach flu-and they remain silently contagious for several weeks after the symptoms abate,”Atul Gawande writes in Better: A Surgeon’s Notes on Performance.
By 1955, however, the first vaccine for polio was introduced by Jonas Salk in the University of Pittsburgh. A more effective vaccine for huge polio outbreaks was discovered by Albert Sabin in 1960, and a steadfast immunization effort began around the world.
Today, the developed world is rid of this dangerous virus. But in developing nations, random outbreaks of polio still occur, even after massive immunization efforts overseen by the WHO. According to a UNICEF report released in early 2008, the polio-endemic (polio is restricted typically to regions within the country) countries are India, Pakistan, Nigeria, and Afghanistan. In these third world nations, the challenges are many. “In India the inadequacy of funds has been a huge roadblock thus far,” says Deepak Kapur, Chairman of Rotary International’s India National PolioPlus Committee in New Delhi.
There are other frustrations, too: few public health centers in remote areas, lack of routine immunization and follow-up, low socio-economic status, density of population, and unhygienic living conditions. Then there are geographic hurdles. “It takes nearly three hours to reach some of the remote villages in Bihar from the nearest PHC (Public Health Center) on a two wheeler,” says Kapur. To get to remote villages, health workers sometimes transport vaccines in refrigerated packs on two-wheelers.
The Last One Percent
When Rotary began its eradication work in 1985, polio infected more than 350,000 children annually. In 2007, fewer than 2,000 cases were reported worldwide, and thanks to Rotary and its partners, the number of polio cases has been slashed by more than 99 percent, preventing five million instances of childhood paralysis and 250,000 deaths.
Those working on the project agree that the last remaining one percent will be the most difficult and expensive to prevent for many reasons.
The complexity of the task of eradicating polio in a country with no routine immunization program in rural areas does not escape Linda Venczel, Senior Program Officer for the Global Health Program at the Gates Foundation in Seattle, Washington. Venczel points out, however, that research has advanced and so has the efficacy of the tools. For instance, health workers now inject a monovalent vaccine (using one strain of virus which has been found to be twice as effective in creating an immune response) as opposed to the old trivalent vaccine. Venczel is optimistic about eradication from polio-endemic regions provided the follow-ups are thorough.
“I think it’s technically feasible,” she says. “We have the tools and the vaccines, and it’s been demonstrated in over a 100 countries that we’ve eradicated polio successfully. It’s only in endemic countries where there have been different reasons for not achieving final eradication.”
In addition to poverty and poor sanitation, when ignorance and misconceptions prevail, the results are tragic, as Gawande notes. In his book, he describes his meeting with a villager holding her paralyzed child in a village in Karnataka. He learns that a health worker had indeed come around with polio drops weeks before her daughter became ill. “But she had heard from other villagers that children were getting fevers from the drops. So she refused the vaccination.”
Over 100 years ago, the founder of Rotary International coined a creed to guide an organization that today consists of 1.2 million members worldwide: “Service above self.” Watching the team spirit of the Rotarians at the Quinlan Center leaves little doubt about the power of passion and selflessness. Against that aggressive army of Rotarians (many of whom are retired CEOs and Mayors), it seems the last polio virus will wither, dry, and drop, exactly the way of the smallpox virus.
Nihalani is passionate about his role in a global mop-up of polio: “I personally feel enormous pride, excitement, and moral satisfaction that a polio-free world is in sight and that our little effort will go a long way to ensure healthier and happier children who will lead a beautiful life.”
Support PolioPlus by attending “Ehsaas Hai?” featuring Pandit Hariprasad Chaurasia and Pandit Habib Khan, in concert at the Flint Center in Cupertino, Calif., on October 11.
|Kalpana Mohan is a freelance writer in Saratoga, Calif.|