Polio: Where Are We Now… After 30 Years of Dedication and Hard Work? Prepared for Chester Rotary Club November 6, 2018

This Is Polio A virus, not a bacterium 3 strains; only one now active Highly infectious; affects mostly children less than 5 yrs. old Spreads though bodily secretions and feces Attacks nerves in the spinal cord

This Is Polio (con’t) Interrupts flow of impulses, causing death or paralysis “Iron lung”, a treatment that saved some But no cure. Irreversible paralysis. Prevention the only answer

What Viruses Remain? Of 3 strains of the virus, only Type 1 remains Last case of Type 2 was in 1999 Last case of Type 3 was in 2012 Only 3 countries – Afghanistan, Pakistan, Nigeria have cases of the wild polio virus Geopolitical uncertainties prove challenging

Important Statistics In 1988 – 350,000 cases in 125 countries To date in 2018 only 25 cases in 2 countries: 19 in Afghanistan; 6 in Pakistan. Nigeria not yet certified

The Scale of Work in 2017 Rotary and partners immunized 430 million children in 39 countries: Afghanistan Niger Angola Indonesia Nigeria Benin India Pakistan Cameroun Iraq Republic of the Congo Central African Republic Kenya Sierra Leone Chad Laos Somalia Cote d’Ivoire Liberia South Sudan Democratic Republic of Congo Libya Sudan Djibouti Madagascar Syria Equitorial Guinea Mali Tajikistan Ethiopia Mauritania Uganda Gabon Mozambique Yemen Guinea Myanmar Guinea-Bissau Nepal

Challenges We Must Overcome We’re also fighting vaccine-derived poliovirus Oral polio vaccine contains some live weakened polio virus Weakened virus stimulates an immune response in child Child excretes vaccine-virus Usually a good thing because it creates immunity in other unvaccinated children Rarely it mutates back into a more virulent strain that can cause paralysis. Vaccine-Derived Polio Virus(VDPV)

Challenges in Conflict Zones Yemen – world’s worst humanitarian crisis Polio vaccinators cross rough terrain, brave hostile frontlines, climb mountains Yet, in 2017 40,000 vaccinators administered drops to 5.3 M children Families wait and welcome vaccinators who use a donkey to carry the gas cylinder that powers generator to keep vaccines cold

And Profound Impact in Other Conflict Zones Nigeria – declared polio-free but new case uncovered in released Boko-Haram captives Now need one more year without polio to be declared polio-free Afghanistan – nomadic populations, insecurity, difficult terrain pose challenges but overcome with transit center and point of entry vaccinators

More Conflict Pakistan – reduced infections by 90%; also re-purposing local health systems to fight measles, meningitis, tetanus complications. Syria – outbreak in 2017 so vaccinators went to transit centers and camps and cities during cease-fires

The Best Solution High immunization rates are best protection against wild and vaccine-derived polio viruses Many countries use inactivated polio vaccine (dead virus) to avoid risk of VDPVs But oral polio vaccine is the only vaccine to prevent transmission of WILD polio virus When world is certified polio-free, only inactivated polio vaccine will be used

The Search Is On for the Silent Killer! Besides the immunization work, there is more In final stages of polio eradication, environmental surveillance is key: Workers collect water samples near sewage treatment plants, open canals or streams

And More Sleuthing…….. Samples are transported to a GPEI Lab Virologists test for polio and determine exact genetic makeup of virus if one is found Doctors, traditional healers, clerics report paralysis cases to medical authorities

………Search Continues Stool samples are taken within 48 hours of paralysis onset Scientists and virologists identify genetic sequences; identify and map where virus originated This data then drives best immunization strategy for health workers

A Magnificent Infrastructure GPEI has 146 labs accredited by WHO In 92 countries And has created health infrastructures in countries that previously had none This infrastructure stopped Ebola outbreak in Nigeria within 3 months

What Does This All Mean??? 17.4 M people walking today because of you; 2.5 B children immunized >1 M Rotarians volunteered time and treasure to eradicating polio

Meaningful!! PolioPlus is the largest private/public health initiative in the history of the world Rotary – largest non-governmental contributor to polio eradication: more than $1.7 billion.

The Cost/Benefit Realities We must eradicate polio in the last three endemic countries – Afghanistan, Pakistan, Nigeria…… and Certify polio-free after 3 years Remember, polio is just a plane ride away Viruses know no borders Eradication is the most cost-effective strategy

Cost/Benefit con’t Cost of CONTROLLING vs. ERADICATING is much higher. We have no choice Eradication translates into much lower health care costs Economic value of a healthy person over a paralyzed polio patient is significant If we cease vaccination efforts, >200,000 children each year will be paralyzed within 10 years We must go forward – We’re this close!

What Can You Do? PolioPlus - primary goal of The Rotary Foundation so we must continue to fund it Support club and district fund-raisers Every $1 donated by you is matched 2:1 by Gates Foundation and becomes $3 Share our mission with non-Rotarians

And Thank You, Rotarians, for Your Support

We Can’t Stop Now Our promise to the children of the world in 1988: Eradicate Polio We Must Keep Our Promise! THANK YOU!! Sources for more information about Polio www.rotary.org www.polioeradication.org www.endpolionow.org www.historyofvaccines.org cjanewilliams1@gmail.com