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GAVI senior program manager
A volunteer checks the little finger of a child to see whether it has been immunised against polio, and administers a drop of oral polio vaccine while the child is still sitting in the traffic during an April 2008 immunization effort in India. Source: Rotary International/2008.
When the news came through in Andhra Pradesh that we had our first polio case for seven years, I was advising the state government on introducing hepatitis B and Japanese encephalitis vaccines.
Mainly affecting children under five, polio can lead to irreversible paralysis for about one in 200 infections. It can also lead to death if the paralysis interrupts the breathing.
Those who have lived and worked in less-developed countries are all too familiar with the terrible disability and deformation that polio leaves in its wake.
But, as with smallpox, polio is one of a handful of diseases that cannot survive for long outside the human body. And eradication is a real possibility.
When we have such effective vaccines, the single biggest obstacle to polio eradication is the strength of our immunisation systems. If the routine immunisation system is working, polio will not spread.
So while the child’s parents were willing him to survive and adjusting to the likelihood that survival would also mean permanent disability, I was fretting about our system. The next 30 cases highlighted weaknesses, but a well-aimed immunisation campaign finished off the outbreak.
A social health activist administers drops of the oral polio vaccine to a child in April 2008 during a door-to-door immunisation effort in India. Source: Rotary International/2008.
Around the world, high immunisation coverage with four doses of oral poliovirus (OPV) vaccine for infants has been key to polio eradication efforts. Indeed, enormous synergies exist between polio eradication and routine immunisation, because routine immunisation systems are still the most efficient and effective way of getting polio vaccination to where it’s needed most.
Persistent transmission in Pakistan and major outbreaks in Chad and the Democratic Republic of Congo reflect ongoing weaknesses in immunisation systems.
My country, India, is one of four countries in the world where polio is endemic, but since January 2011, it has not seen a single case of polio. This shows that eradication is possible.
Eradicating polio will be a tremendous demonstration of immunisation’s power, allowing countries like my own to focus on other life-saving vaccines.
Victory against polio will be triumph for us all.
Dr Raj Kumar is an Indian national. Between 2002 and 2006, he advised the state of Andhra Pradesh, population 75 million, on immunisation. Now as a Senior Programme Manager for GAVI, he manages GAVI’s portfolio in 13 countries across the Middle East and East Asia.
Raj KumarGAVI senior program manager, Afghanistan
My recent trip to Afghanistan is one of the most satisfying trips I have done for GAVI. Security remains difficult, but the sense of optimism is palpable. We’re supporting immunisation in Afghanistan, working with our partners in-country who are bursting with innovation and enthusiasm.
This exquisitely beautiful country introduced the pentavalent vaccine in 2009, protecting Afghan children against five deadly infectious diseases with a single course of three injections. This incredibly cost-effective vaccine literally saves tens of thousands of young Afghan lives every year. And because it’s a five-in-one vaccination, it saves on money, time and transport, too.
Now our colleagues in the health ministry are pressing to know more about the new pneumococcal and rotavirus vaccines that help protect against pneumonia and diarrhea, two of the world’s biggest killers of children. I’ve always gotten a buzz from working with immunisation, an incredibly simple technology at heart. The challenge is to save lives on an enormous scale in the most sustainable and cost-efficient manner.
There’s something even more special about doing it in a context of murderous instability. A previous visit in 2008 began with news of a suicide bomb that killed two of our colleagues from WHO. Conflict has been rumbling throughout this mountainous country for more than 30 years now.
No wonder its health system is such a wreck.
As in many other fragile states, though, Afghanistan’s NGOs do a fantastic job of providing basic health services to the population. That partly explains why some of Afghanistan’s basic health indicators have been improving rapidly.
Maternal mortality ratios have fallen by about a quarter in the past six years, and with immunisation coverage rates doubling in the previous decade, we will soon see large reductions in child mortality, too.
Afghanistan is still one of the world’s poorest countries, likely to remain heavily dependent on external donors for quite a while to come. But with GAVI helping protect young children from vaccine-preventable diseases, I'm also optimistic for the future.
© GAVI Alliance 2013
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