Polio eradication program faces hard choices as endgame strategy falters

Childhood vaccination program provides one of the most cost-effective public health interventions. Vaccination prevents about 2-3 million deaths a year.1 Disease elimination and eradication programs are one of the most effective way to interrupt disease transmission, which results in reducing morbidity and mortality. After successful eradication of small pox in 19772, the world is close to achieve the goal of polio eradication. Polio eradication program has evolved since its beginning around three decades ago. However, the program has seen several challenges during this time around the globe. Hesitation to vaccinate remains one of the most important factors to determine the course of eradication program. Vaccine hesitancy is “the reluctance or refusal to vaccinate despite the availability of vaccines”.1 Any factor affecting the public trust in vaccine safety, purity or efficacy can result in variable level of vaccine hesitancy.3-5 Vaccine hesitancy, if not addressed timely and effectively, can hamper the progress of the program and pose challenges to completion of the disease eradication and elimination programs. Vaccine hesitancy affects the coverage and has impact on overall immunity levels and it needs to be taken seriously. Among all public health interventions, immunization programs were able to investigate the details of the reasons for not vaccinating children. Probably, to our knowledge, the polio program has underwent the most in-depth exploration on the causes of reluctance to vaccinate than any other public health program. However, vaccine hesitancy is comparatively difficult to capture in routine immunization program. Vaccine hesitancy becomes more obvious during supplementary immunization campaigns as the interventions are for brief time and the time taken by community to react to intervention is short as well. While the goal of eradicating polio is near, the issues of vaccine hesitancy are still adversely affecting the global eradication of polio.

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Rethinking disease eradication: putting countries first

International Health ◽

10.1093/inthealth/ihab011 ◽

2021 ◽

Vol 13 (3) ◽

pp. 215-221

Author(s):

Teshome Gebre

Keyword(s):

Public Health Problem ◽

Polio Eradication ◽

Cold Chain ◽

Health Programs ◽

Huge Amount ◽

Disease Eradication ◽

Total Cost ◽

Eradication Program ◽

Guinea Worm ◽

The One

Abstract There have been various infectious disease eradication programs implemented in various parts of the world with varying degrees of success since the early 1900s. Of all those programs, the one that achieved monumental success was the Smallpox Eradication Program (SEP). Most of the global health leaders and authorities that came up with the new idea of disease eradication in the 1980s tried to design and shape the new programs based on their experience in the SEP. The SEP had a very effective tool, vaccine, that did not require a cold chain system, and a relatively simple way of administration. The total cost of the eradication program was about US$300 million and the entire campaign took about 10 y. However, the Guinea worm and polio eradication programs that followed in the footsteps of SEP attained varying levels of success, consuming a huge amount of resources and taking a much longer time (>30 y each). This paper reviews the factors that played major roles in hindering the attainment of eradication goals and outlines possible recommendations for the way forward. Among other things, this paper strongly emphasizes that endemic countries should take the lead in all matters pertaining to making decisions for disease elimination and/or eradication initiatives and that ‘elimination as a public health problem’ is the preferred option rather than going for complete eradication at the expense of other health programs and thereby contributing to weakening of already fragile health systems, mainly in Africa.

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