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Science Magazine Examines Efforts To Improve Disease Eradication Programs

Years after deadlines for polio and guinea worm eradication came and went without achieving their intended goals Science magazine examines efforts to strengthen disease eradication. The topic was front and center of a meeting of public health experts earlier this year in Frankfurt, Germany, that “sought a new way forward” on disease eradication, the magazine reports. “The participants, many of them involved in past and current eradications, believed that eradication campaigns should continue. But ‘proceed with caution’ could have been the motto” of a report the group drafted during the meeting, according to Science.

The magazine writes, while “[w]ealthy countries in particular are determined never to let their guard down against diseases like smallpox, polio, or measles[,] … developing countries have their own questions [about disease eradication campaigns]: Why should they keep spending inordinate amounts of time and money on a disease such as polio – now down to fewer than 2,000 cases a year – while their health systems are struggling with far more devastating diseases such as AIDS and TB?”

The article examines the history of disease eradication efforts, comparing the success of the smallpox eradication campaign to several barriers the malaria and polio eradication campaigns have faced, and documents how “tantalizingly close” public health experts believe they are getting to wiping out guinea worm. The piece also looks at several challenges disease eradication efforts can foster in countries also grappling with other health issues.

“Future eradication campaigns [cannot] afford to bypass poor countries’ broader health concerns, like diarrhea or respiratory disease, which kill far more children, the group [gathered in Frankfurt] concluded,” according to Science. “Eradication programs should not hurt existing health services by siphoning away money and effort from basic health services for an increasingly rare disease, the Frankfurt report says – and to the extent that they can, they should have a broader beneficial effect,” Science continues.

The report also called for future disease eradication plans to “be more evidence-based than the old ones,” as well as consider the “economic costs and benefits” to eradication campaigns. The article includes comments by Stephen Cochi of the CDC; Walter Dowdle, a consultant for the Task Force for Global Health; Donald Hopkins of the Carter Center; T. Jacob John, a member of the India Expert Advisory Group for Polio Eradication; Eric Ottesen of the Lymphatic Filariasis Support Center at the Task for Global Health; and Stewart Tyson, a consultant at Liverpool Associates in Tropical Health in the United Kingdom (Enserink, 12/24).

Scientists, Public Health Officials Weigh In On What Polio Outbreak In Republic Of Congo Could Mean For Other Regions Of Africa Believed To Be ‘Polio-Free’

“Polio is a horrendous disease, but it is seldom fatal—except now. An explosive outbreak in the Republic of Congo is writing another chapter in the book on how this ancient scourge behaves,” Science magazine writes in an article that examines how the recent outbreak has scientists and public health experts scrambling to figure out how to control the virus.

“Polio usually strikes children under age 5, paralyzing one in 200 of those infected and killing at most 5%, occasionally up to 10% in developing countries. The new outbreak tearing through this West African country has so far killed an estimated 42% of its victims, who, in another unusual twist, are mostly males between the ages of 15 and 25,” Science writes. According to the WHO, the outbreak, which first emerged in October, “has paralyzed more than 476 people and killed at least 179 … making this one of the largest and deadliest polio outbreaks in recent history.”

The magazine adds, “The Republic of Congo – also known as Congo-Brazzaville … had rid itself of polio in 2000 through countrywide campaigns to vaccinate each and every child. Since then, routine immunization has kept Congo-Brazzaville polio-free, even when outbreaks swept neighboring Angola and D.R.C.,” leading officials to first overlook polio as the source of the health issues when they first cropped up. While “[o]utbreaks among adults are not unheard of—one in Namibia in 2006 was traced back to inadequate routine vaccination some 16 years earlier. … there had been no such breakdown that anyone knew of in Congo,” Science writes.

The article reports scientists’ thoughts on the potential causes for the outbreak, why the polio virus affecting the populations in the Republic of Congo is proving so deadly, and fears that what’s happening in Congo-Brazzaville could happen in other “polio-free parts of Africa.” The piece also notes current efforts to “snuff out the outbreak before the virus reinfects other countries,” including emergency vaccination campaigns.

Bruce Aylward who runs the WHO’s polio eradication effort; Neal Nathanson of the University of Pennsylvania; and Mark Pallansch, who according to Science “is leading efforts to analyze the [polio] virus at the U.S. Centers for Disease Control and Prevention” are quoted in the piece (Roberts, 12/24).

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