This blog was originally posted by By Matthew Alexander on POLYGEIA‘s blog *
Just over a fortnight ago, 27th March saw India declared a Polio-free country; it has been over three years since 18 month-old Rukhsar Khatoon was diagnosed with the last case in South-East Asia. The disease left her with mild paralysis in her right leg.
Only three decades ago, 200,000 children per year were left with disabilities due to polio in India, and in 2009 India was still the site of 741 of the world’s 1,604 cases. Now, following the elimination of polio from India, 80% of the world is polio free. [1] The final push will involve mass vaccination of remaining endemic countries: Afghanistan, Niger and Pakistan, but with one-hundred children recently infected in Syria there is a race to prevent new epidemics before the 2018 eradication target. [2]
The Polio virus will not be the first pathogen to be eradicated by human intervention. The Variola virus (the causative agent of smallpox) has been extinct in the wild since 1977, and more recently in 2011, the Rinderpest virus was declared eradicated by the OIE. [3] The successful Smallpox campaign cost $1billion in today’s currency, with two-thirds of the financial burden on the endemic countries; this is in stark contrast to the polio programme with the Post Graduation Education Institute (PGEI) estimating that the next four years will cost $5.5 billion in addition to the billions already invested since the 1980s. Yet there is still a strong economic case for eradication, with returns of $25 billion in as few as two decades when compared to routine immunisation. [4]
So what does polio elimination have to do with Neglected Tropical Diseases (NTDs)? Like the polio virus, many of the pathogens that cause NTDs are eradicable; they cause debilitating symptoms that hinder economic and social activity; they cause much suffering to the afflicted and their families; in total, 1.7 billion people are at risk of developing these diseases. Of the 17 NTDs listed by the WHO, two are set to be eradicated worldwide and 10 have co-ordinated programmes to eliminate the disease from endemic populations, all within the next 10 years. [5]
In 2004, another disease was eliminated from India to a much smaller fanfare; Yaws begins as a cutaneous infection and spreads to cartilage inflicting disfigurement and disability. The causative pathogen, a bacterium of the Treponema pallidum species, is easily treated with a single oral dose of azithromycin and yet Ghana, Papua New Guinea and the Solomon Islands report over 10,000 cases per year. WHO hopes for its eradication by 2020 through a programme of identification of endemic areas and blanket treatment. [5]
The NTD policy team members of Polygeia are working hard to find areas where we can take novel ideas and apply them effectively to real world situations. My personal interests lie in the use of mobile phones and SMS to improve uptake of available testing, counselling and treatment concordance. Much work has been done in HIV and TB treatment with schemes such as WelTel showing promise. Under this programme, HIV positive patients were required to respond to weekly texts from a nurse and then outcomes were compared to a control group receiving standard care. Those receiving texts were 19% less likely to be non-compliant and 16% less likely to show failure of viral suppression. In other words, for every 11 people treated, one would remain well who may otherwise have developed AIDS. [6] We hope to develop policies that will take successful concepts in eMedicine to the fight against NTDs.
References:
[1] Basu, M. India beats the odds, beats polio. CNN, 27th March 2014
[2] Whewell ], T. Polio in Syria: An outbreak that threatens the Middle East. BBC, 26th March 2014
[3] Rinderpest Eradication, Bulletin No. 2011-12, OIE, Feb 2011
[4] Economic Case for Eradicating Polio, PGEI, 2013
[5[ Sustaining the drive to overcome the global impact of neglected tropical diseases, WHO, 2013
[6] Yaws fact sheet No. 316, WHO, 2014
[7] Lester R. T. et al, 2010. Effects of a mobile phone short message service on antiretroviral treatment adherence in Kenya (WelTel Kenya1): a randomised trial. The Lancet, Vol. 376, Issue 9755
*Polygeia was founded to give students the opportunity to contribute to global health policy. Its core aims are:
- Research and disseminate high quality policy papers and follow up on their implementation where possible.
- Develop the skills of our researchers through our policy workshops and mentoring programme.
- Engage students and others with the global health issues on which we are working.