The global polio eradication effort suffered an unexpected setback this year. An outbreak began in February in Tajikistan, which had not seen a case of polio in 19 years, and 452 cases have been confirmed as of August 5.1 From there, it has migrated to Russia, where it has infected seven individuals.1,2 Russia’s last confirmed case of polio was in 1996. This outbreak is a discouraging reality check for a two-decade eradication effort that hovers on the edge of success but cannot quite seem to reach it.
After the successful eradication of smallpox in 1979, global health organizations have pushed a similar “vertical” approach to eradicate other disease.3 The polio eradication campaign, which began in 1988, has been aggressively carried out with a similar mindset and has been largely successful. Incidence has been reduced by over 99%, with less than 1,000 cases reported in the year 2000 compared to 350,000 in 1988. In Africa, ten of the 15 previously polio countries re-infected in 2009 successfully halted their outbreaks.4 It is currently only endemic in Nigeria, India, Pakistan, and Afghanistan.2,4 For the last ten years, however, the initiative has “hovered on the verge of victory” without being able to reach it.5 There were 1,604 cases in 2009, and 576 cases have been confirmed globally so far this year.2 The effort has cost approximated $8.2 to date.3
The long-standing fight against polio has raised an interesting discussion about this and similar approaches to public health: are singularly-focused health efforts such as disease eradication the best way to work toward health improvement? Large scale donors, such as the Gates Foundation and Rotary, typically prefer these “vertical” strategies because the benefits seem clearer and more immediate; “horizontal” strategies, on the other hand, such as strengthening health systems, training workers, and increasing supplies, have less well-defined goals, and long-term change is much more difficult to measure.3 The ongoing struggle for polio eradication has re-energized this debate. Global health stakeholders responded in June with a new Strategic Plan, which builds on findings from a recent independent evaluation of the eradication effort and proposes a combined approach of area-specific strategies to target remaining reservoirs of polio and targeting health system weaknesses.4 This plan will hopefully inspire organizations working in the effort to make the final push toward wiping out polio for good. When the plan was unveiled in Geneva, however, Dr. Margaret Chan of WHO called on the international funding community “stand tall for polio eradication,” reminding us that the effort can still falter in the face of economic crisis if funding lapses. It will be interesting to see how much longer smallpox will stand alone on the list of eradicated diseases.