WHO experts try to reconsider goal of ending polio.

March 3, 2007

Experts reconsider goal of ending polio WHO experts pose bleak question on global health prioritiesThe Associated PressUpdated: 6:16 p.m. ET March 1, 2007http://www.msnbc.msn.com/id/17405219/LONDON

- Nearly 20 years ago, the World Health Organization and its partners

launched an ambitious program to eradicate polio by the end of the

millennium. That deadline passed and another was missed in 2005 — and

polio still strikes about 2,000 people a year, mostly children.At

a WHO meeting this week, some leading experts asked a grim question: Is

it time to abandon the goal of eradication and focus instead on

containing the disease? The answer, for many, was no — even though many had doubts."Many

people wonder why we are spending all this time and effort on polio

when there are much bigger problems," said Dr. Donald A. Henderson, who

headed WHO's smallpox eradication program in the 1970s. Smallpox is the

only disease ever to have been eradicated.There

is no question the polio eradication program has reaped rewards: Since

it began in 1988, the incidence of the disease has dropped by more than

99 percent. But with the number of polio cases at a virtual standstill

for the last five years, some experts worry that the campaign by WHO

and its partners — the U.S. Centers for Disease Control and Prevention,

Rotary International and UNICEF — is running aground."Even

if things quiet down in the countries where we have problems, there

will be another area that bursts into flames," said Dr. Ellie

Ehrenfeld, who sits on the WHO Advisory Committee for Polio Eradication."We

are living in a different world where I'm not sure what eradication

means anymore," said Ehrenfeld, who was not invited to Wednesday's

meeting.Critics of the eradication program

note smallpox was wiped out in a decade, while the polio campaign is

entering its 19th year. WHO is seeking a $575 million budget for polio

eradication for 2007-2008.In a speech to participants, WHO Director-General Dr. Margaret Chan urged participants not to give up.'Last chance to eradicate polio'"We

are facing our best and perhaps our last chance to eradicate polio,"

she said, adding that leaving the job unfinished would squander the

more than $5 billion invested so far because it would open the way for

a resurgence of the disease.The four polio-endemic countries _ Afghanistan, India, Nigeria and Pakistan — are also intent on ridding the world of the virus."We

will spare no effort in eradicating polio," said Naresh Dayal of

India's Ministry of Health and Welfare. This year, India will spend

$286 million to fight the polio virus."While eradication is possible, we shouldn't even consider moving to a control strategy," said Dayal.Others are not convinced.‘There is a limit’"We

cannot continue forever," said Dr. Isao Arita, another WHO smallpox

veteran. "Everyone wishes WHO to accomplish the task but there is a

limit."For WHO, giving up on eradication would a crushing blow."There's

an almost religious conviction that they must see this through," said

Dr. Samuel Katz, an infectious diseases specialist at Duke University

and co-inventor of the measles vaccine."But

there are other things we could do that would be as beneficial to child

health rather than spending another billion dollars in frustration," he

said.In the countries where polio occurs,

there are many competing health priorities, including respiratory and

diarrheal diseases, malaria and AIDS.Some

experts say that a polio containment policy wouldn't necessarily be

radically different from an eradication policy, except that it would

free up money for other health problems.Tighter

regulation in countries where polio occurs could help trap the virus,

and international officials might adopt measures such as requiring

proof of vaccination for travelers coming from polio-endemic countries.WHO and its partners insist it is possible to eradicate polio, and that the only challenges are logistical.Border-hopping virusDifferent

problems plague the four endemic countries: In Nigeria, the weak health

system coupled with a vaccine boycott in some areas gets the blame; in

Afghanistan and Pakistan, the virus moves back and forth across the

border where the official focus is on the war on terror; in India,

children are often infected with other viruses, making the polio

vaccine less effective.Some experts think

a different vaccine could help. The eradication campaign uses the oral

vaccine because it protects entire communities. But while the oral

vaccine is cheap and easy to administer, there is a downside: For

approximately every 2.5 million doses, it causes one case of polio.WHO

is looking into the more expensive injectable polio vaccine, which uses

an inactivated virus that cannot trigger polio. Results from the

studies won't be available until next year.WHO insists it is considering all options — except giving up on eradication."Any

program would be negligent if it didn't check all the possibilities,"

said Dr. David Heymann, WHO's top polio official, "but our partners

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