To most Americans, polio is a disease from the past, a successful health campaign to be glorified in the history books. But around the globe it's a different story.
The Global Polio Eradication Initiative (GPEI) is arguably the greatest-ever act in the name of the public good. It has taken 18 years of coordinated effort by millions of healthcare workers and volunteers in every country. It has cost $4 billion. It involves vaccinating every child on the planet time and time again—and at this very moment it may be on the brink of success. But the stakes are unspeakably high: if the program fails, or misses a few infected children, or gives up in frustration at an apparently endless sequence of obstacles, the entire world could be re-infected within five years.
Despite goals to eradicate the incurable disease globally by 2000 and then 2005, health officials continue to go village to village, in countries such as Nigeria, India and Afghanistan—and just this week in Iraq—to chase the infectious disease out of existence.
Tim Brookes, author of The End of Polio? Behind the Scenes of the Campaign to Vaccinate Every Child on the Planet (with Omar A. Khan, M.D.), joined an immunization campaign in Pakistan and discloses the successes and obstacles affecting the final goal. It's a particularly daunting task in countries that are torn apart by war.
Brookes' book is a first in that it is the first time anyone has reported on eradication campaign while it is happening from the field.
Dr. Margaret Chan, appointed the new World Health Organization (WHO) director-general in Geneva on November 9, vowed last week: "We will complete polio eradication."
"This initiative is as ambitious as us putting a man on the moon in 1969," the author says, "and it has already taken twice as long."
In his book, Brookes, director of the Professional Writing program at Champlain College in Burlington, Vt., tells the story of these challenges in a readable and accessible narrative, clearly showing the scope of the eradication program, the challenges that remain, and the consequences of failure.
One of the challenges he describes is parents who must trust a vaccinator, often a stranger, enough to allow their child to be vaccinated. He writes about planners who map the areas where vaccinations must be provided, health workers who identify where children are being paralyzed, and laboratories that confirm where the polio virus is circulating. He uncovers the process wherein political leaders are engaged, or not, to ensure that eradication activities can proceed, and the traditional and religious leaders who relieve the fears and anxieties of parents as they prepare communities and their inhabitants for vaccination campaigns.
Brookes also points out that at the Pakistan-Afghan border, there are a cluster of problems that may be insurmountable. One is that the border is not heavily patrolled: there is no definitive line and smuggling remains an issue. "It is impossible to prevent weapons or drugs or goods from being smuggled, so one has to wonder how we can prevent a virus, which can hide in the gut, from crossing the border. As a result, the polio virus is endemic on both sides of the border and no one knows which side it is living on. Each side continually reinfects the other. This happened in China when a single infected truck driver crossed the border."