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Live TED Conversation on Polio Eradication: Join TED Speaker Bruce Aylward on July 21st at 4.30-6.30 pm Central European Time

LIVE conversation with Bruce Aylward, TED Speaker and Physician, Epidemiologist who heads the Polio Eradication program at WHO, The Global Polio Eradication Initiative ( GPEI)

The conversation will open at 10.30 am-12.30 pm Eastern daylight Time/ 16.30 until 18.30 Central European Time,  July 21st , 2011 with the question:

Polio eradication requires pretty much every country in the world to pull together, How do you get so many different players to agree on something so complex and spread out both in time and geography?

In my talk, I've explained why polio can't really be controlled, only eradicated: What are your thoughts on the three things we need to actually achieve that?

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    Jul 21 2011: I always worry most about the obstacles that the public health field faces when trying to get the vaccines to those who need it most. According to the polio map in your TED talk, many of the countries that still have cases of polio are also countries facing war. Not only are there problems with traveling through the fire zones to vaccinate children, you also have to worry about refugees displacement. As populations flee the conflict zone, they also carry the virus with them and might end up infecting other countries that has already been free of the virus. I see this happening with the war in Congo, the civil unrest in Nigeria, the wars in the Middle East, and so on.
    I know I haven't offered any solutions, but I do think that war and its effect on population displacement is definitely something to think about.
    • Jul 21 2011: I agree with you Dany. Migration of populations has been a main reason for the spread of the virus, not only between countries, but also within a country.
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    Jul 21 2011: Thank you Bruce for taking part in this conversation. I've learned a lot from you and the people who commented. I definitely got some ideas worth spreading in this conversation
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    Jul 21 2011: Hey Bruce,

    I've never met or known someone to be diagnosed with Polio. I haven't the slightest clue what kind of information or help I would be able to give if a friend came to me and told me that they have Polio.

    What are some of the first things that come to your mind when attempting to deal with loved ones or friends that are diagnosed or are survivors?
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      Jul 21 2011: Corvida, if you were born after 1950 in an industrialized country, it's pretty unlikely you would meet someone with polio. But anyone who remembers that time knows what it is like - the sudden fever and paralysis, the overnight paralysis of a child who was healthy hours before. As Ari mentioned before, even if you recover from the paralysis, post-polio pain can come back in later years. This is why it is so important to eradicate polio - there is no cure, and no real help for polio survivors, and eradication is the only way we can protect future generations.
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        Jul 21 2011: Out of curiosity, what sort of help is given to those (especially children) infected with polio? Is there help given to adjust their lifestyle? Must the families search for and purchase crutches with the little they have? Or are they provided (and by whom)?
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        Jul 21 2011: We are dying without treatment and, second movement gradually, with pain.We need a Help.We can waiting.....thanks..
  • Jul 21 2011: Indeed Rotary has done a lot - which I hadn't realised until I watched Bruce's talk. I recently published an interview on this very subject
    http://www.vaccinestoday.eu/vaccines/%E2%80%98we-can-beat-polio%E2%80%99/
    I'm not a Rotarian but can see they do great - often unseen - work in this area

    So, if money is the limiting factor, where should we look for the cash?
    Is it wealthy (albeit heavily-indebted) Western governments who need to do more or are you looking to the private sector and private individuals?

    What about companies who make vaccines? I know they've done a lot but can they do more?
    (Disclosure: I work on a website funded by some of these companies but ask this question wearing my 'concerned citizen' hat)
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      Jul 21 2011: Dear Gary - we look for cash EVERYWHERE! Clearly the starting point has got to be a combination of G8 and OECD countries, but it is critical that the G20 play a greater role to close the financing gap. As important - and almost always under-recognized - is the critical role of the polio-infected countries themselves. Most people are not aware, for example, that the Government of India's domestic contributions to polio eradication have been larger than that of any G8 country or other donor! We are also, especially through our partners, continuing the financing dialogue with the private sector and private individuals - again, Rotary have been the superstars in this regard and we really hope others will join their movement.
      In terms of the vaccine manufacturers, these have been absolutely vital partners in the eradication effort - in the last 5 years, for example, they have developed 4 new vaccines (mOPVs and bOPV) to help address emerging challenges and improve our tools. This past year they did reduce the average price we pay for these products as part of their contribution to the effort. That said, with the financing gap as challenging as it is we will be going back to discuss whether they can still help further on the price of their vaccines!!
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    Jul 21 2011: Hello Bruce, While on an NID in Nigeria it was noted by health officials that the assistance from UNICEFF sending in staff members with local health and community leaders a couple weeks before the SNID to approach both community and religious leaders helped tremendously in solving the resistance to immunization of their children. Is this tactic still being used?
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      Jul 21 2011: In fact, it is the community and religious leaders themselves who have been taking the lead on polio eradication efforts in northern Nigeria - they have largely been the reason for the tremendous success (so far...) in that country over the past 18 months. UNICEF and other polio partners play a role in helping fill the gaps when/where this might not happen or where the local efforts of community and religious leaders could benefit from further support. So yes, this tactic is very much still a key part of the eradication effort.
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        Jul 21 2011: It is important to point out though that while the local Government and Religious leaders were very helpful, many pointed out that the tactic of going into those areas with the professional support of UNICEF or another NGO necessary.
  • Jul 21 2011: One of the key positive developments in recent years - that I think has been under-publicized to both the general and professional communities - has been the development of tools that show that wild polio strains recovered from patients are become much less genetically diverse - it shows that some substrains are being eradicated - relatively slowly but also fairly encouraging. Will we be updated soon about the genetic diversity of the WPV3 strains in W African countries & Chad?

    I think the news on genetic analysis of circulating virus is probably as important - if not more so - than the weekly case count summary analysis and other key documents that are very prominent on the polioeradication.org site. It would be great if there were a formal update of this viral genetic analysis every ~6-8 weeks or so.
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      Jul 21 2011: You are absolutely right - the genetic sequencing data - generated by the eradication effort's 'global specialized labs' at the CDC/Atlanta, in South Africa, India, Pakistan and other countries is invaluable in assessing progress (and the quality of surviellance). Right now, as a result of the new bivalent OPV, there are only 3-4 strains of the type 3 poliovirus in the entire world (2 in West Africa, 1 in Chad and 1 in Pakistan). The CDC in Atlanta is playing a central role in establishing a format that we can use to share these data more regularly (probably every quarter - I hope that will work for you!).
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      Jul 21 2011: This is our biggest priority right now - taking the lessons learned from places like India and ensuring their systematic application in the remaining infected areas. A range of activities are used to do this, but by far the most effective has been to deploy large number of public health experts, with a lot of experience in 'best practices' from one area to another. This is one of the largest growth areas in the eradication effort right now.
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          Jul 21 2011: Actually these countries used the same tactics as the rest of the world to eradicate polio - high 'routine' immunization coverage, mass immunization campaigns and surveillance - the big difference, compared with countries that are currently polio-affected, was the strength of the underlying health system. These countries were working from a stronger baseline, so to speak, especially due to their stronger routine immunization programmes. This was critical to helping these countries rapidly stop the outbreaks they suffered after importations last year - despite this they still suffered awful outbreaks last year, a stark reminder of the need to complete eradication!
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    Jul 21 2011: Greetings.
    I understand that the Polio eradication program in India is in the final stages. The number of polio cases have gone down drastically since 2009, onwards. Do you think that there is under-reporting by the staff? In spite of having stringent M&E mechanisms, it's seen that many-a-times the staff members misquote these figures. I know this as I have close associates working in the NPSU, India. What are your thoughts on this? What solutions would you provide? Thank you.
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      Jul 21 2011: I've just come back from India where last week we spent a full 2 days looking very carefullly at exactly this issue - whatever gaps may have existed in the past in terms of reporting, these are or have been addressed in India. We also have a number of tools that allow us to confirm the accuracy of these reports, such as the genetic sequencing data of viruses that rapidly show if, and where, there are any gaps in case reporting.
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    Jul 21 2011: I think 3 things we need to achieve the eradication of Polio are:

    Educating communities on what Polio is
    Transparency about the efforts of the programs that are helping to achieve this goal
    A little love and tenderness (doctor recommended).

    I think the most important of them all is education about Polio.


    As for getting many governments to agree, what exactly are you asking that they agree on Bruce?
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      Jul 21 2011: Donate or volunteer! Individuals can moblize their communities, their politicians and their governments to contribute to raising awareness or funding about the fact that polio still exists among the most deprived children in the world. YOu can remind people that polio still remains and how much suffering it can cause. We have the chance to ensure that no child ever suffers from polio again, and each of us plays a role in that.
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    Jul 21 2011: I'd like to thank everyone who's participated in this TEDConversation - you're obviously getting as hooked on the lure of eradication as we are here at the World Health Organization and in our partner agencies.

    This is a great time to be getting involved as the programme has a whole new momentum thanks to the new tactics and tools that have been brought into play over the past year. To finish the job we still need a lot more people like you spreading the word and building support - help spread the great idea of a polio-free world so we have the resources (that's money!) and commitments we need to finish the job and ensure no child ever again knows the pain of polio.
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    Jul 21 2011: Hello Bruce! Thanks for your wonderful work. The optimist in me wants to know what you will tackle next once polio is irradicated?
  • Jul 21 2011: Devastating floods - with prolonged population displacement - last year in Pakistan seem to have thrown huge reverses to a country whose hard-won advances in polio eradication were fragile. Any predictions about when Pakistan will be able to stop transmission in the more highly populated warmer & lower-land areas that are so conducive to long-seasons of heavy polio transmission?

    Do you think that recent news about the developing severe East African drought poses as much danger to polio eradication as the Pakistan floods last year?
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      Jul 21 2011: Hi Mark
      Indeed Pakistan faced a devastating situation, with massive movements of population and the poliovirus moving with them. However in the lower-lying areas you mention, Punjab has had no cases this year thankfully and Sindh can move quickly if it applies the national emergency plan. The real challenge is in the border areas in the north west, where we have our work cut out for us. The drought situation iin the Horn of Africa is a tragedy. This is fortunately a polio-free area, with countries that have stopped polio before. In the humanitarian response, polio vacccination is already being incorporated.
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    Jul 21 2011: Hi, Bruce. For survivors of polio does not end. and that the program would be good for you include the treatment and recognition of the effects of post-polio syndrome
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      Jul 21 2011: Ari, you are right, and in some countries we are collaborating with disability advocates and rehabilitation groups to help survivors of polio. Once we eradicate polio, no child will have to suffer polio paralysis and no survivor will be haunted by it later in life.
  • Jul 21 2011: Is there any role for an earlier than planned roll-out for the inactivated IPV injectable vaccine in countries like Nigeria, Chad, Mali, Pakistan (while continuing the OPV drop campaign)- that are still struggling to contain outbreaks/transmission. My understanding is that this has been thought to be a relatively bad idea because IPV has much less effect on transmission than OPV and (on its own/without OPV) offers less direct protection as well.

    I wish there were someway to combine an inexpensive IPV into a single combination vaccine with the (attenuated) measles vaccine that addresses such a major problem, especially in so much of Africa... It seems like the planned switch to (an inexpensive) IPV in the post-eradication era is going to be a supertough challenge.
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      Jul 21 2011: Hi Mark - as you may have seen from another thread, there is no plan to roll-out IPV on a large scale in any of the polio-infected countries. In most of these areas there is very compelling evidence that if they get 4+ doses of OPV into most of their kids polio transmission will stop relatively quickly. That said, we are always exploring whether adding this product in certain settings might help to accelerate the initiative in areas where the population immunity threshold for stopping transmission is particularly high.
      In terms of an IPV switch, I think this would have been superb tough even 5 years ago, but there has been fantastic progress in finding cheaper ways to produce and use this vaccine for a post-eradication era, so I am now very optimistic that this would be feasible.
  • Jul 21 2011: Bruce, I consulted the WHO homepage today and was surprised to see that 83 countries and territories report currently using IPV, either as part of the regular schedule or, in some countries, for special groups.

    What do you see as the role of IPV in the next few years? What is the likely timeframe for roll-out of Sabin IPV?

    Bob Davis
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      Jul 21 2011: Hi Bob - there are still lots of opinions on the potential role of IPV in the eradication programme over the next few years and especially in the 'post-eradication' era. I think that as new, much much cheaper ways for using IPV come on line in the next few years (e.g. fractional doses, reduced dose schedules) an increasing number of countries will explore its use in their routine immunization programmes to protect their populations after wild virus eradication. We have an international expert group working right now on this issue to help establish a formal policy framework for low income countries.
      In terms of Sabin-IPV (i.e. a 'safer for production' version of IPV), clinical trials are ongoing in China and Japan as we speak and a consortium we are working with directly is initiating two additional trials this year . We have also just launched technology transfer projects with two developing countries for this product with the goal of full clinical trials with their products within 36 months.
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    Jul 21 2011: Im speak from BRAZIL and have Pos Polio syndrome. We have no references and treatment center here.We are millions in South America and around the world . Our leaders do not deal in public hospitals they even do. How can we ask for help from ONU to intervention..Polio not stop.We need a help...............sorry my inglish..
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      Jul 21 2011: Dear Ari - one of the best sources I have seen for Post Polio syndrome is at http://www.post-polio.org/

      Post Polio Syndrome is indeed a dreadful disease - completing eradication of polio itself will also, eventually, eradicate this consequence as well.
  • Jul 21 2011: What's the biggest obstacle to finishing the job of global polio eradication: money, political will (in the West), or the political situation in countries where polio is endemic?

    How big a difference does it make to have people like Bill & Melinda Gates on board - financially and in terms of sheer name recognition?
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      Jul 21 2011: Just yesterday, the eradication effort's Independent Monitoring Board issued its 2nd report stating that the financing gap was 'deadly serious' and now represents the single greatest threat to completing the eradication effort - this requires urgent action. By contrast, the political support in endemic countries is actually continuing to grow stronger all the time. In June, for example, I participated in a 2 hour meeting with the Prime Minister of Pakistan and their provincial leaders that was specifically on intensifying polio eradication in that country.
      It makes a HUGE difference to have people like Bill & Melinda Gates backing the eradication effort - their energy, credibility and stature have really boosted interest and enthusiasm (as well as innovation!) at a critical point in the effort. At least as important, though, are the millions of Rotarians who have both initiated and complemented such efforts at the international and grassroots levels - this combination is incredibly powerful for a global health initiative like polio eradication.
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      Jul 21 2011: Gary, Speaking on behalf of Rotarians, the involvement of Bill & Melinda has motivated the Rotarians to raise over 170 million of a 200 million Challenge grant 1year before the deadline. That in my mind is motivation and inspiration.
  • Jul 21 2011: Hi Bruce,
    Happy to have you sharing with us. Nigeria has made tremendous progress however, it now appears that perhaps
    we are slipping a bit again in this area. What new and stronger tactics are being introduced to maintain the engagement of local religious, tribal, and community leaders with Rotary's efforts? What is being done to reduce the possibility of
    falsifying reports from some working in the field - or do you feel this is an issue any more?
  • Jul 21 2011: Does the polio exist in Africa ?
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      Jul 21 2011: As Dany just said, polio doe persist in parts of Africa, but the good news is that it is dropping fast. Right now, just 8 countries in Africa are considered to have ongoing polio transmission and in most of these it is quite geographically limited (the exception is Chad which is in the midst of a major outbreak).
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      Jul 21 2011: In many countries. Nigeria, Chad, Gabon, Congo and many others. If you watch Bruce Aylward's TED talk, he shows a map of countries where the virus still exists
  • Jul 21 2011: Hi Bruce -- thanks so much for joining us. Two questions:

    What are the difficulties faced when working with public health officials worldwide?

    It's amazing to me that it is within the realm of possibility to eradicate this disease and yet endemics are still occurring. What strategies are being used to raise worldwide awareness?
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      Jul 21 2011: Hi Will - the problem really is not working with public health officials, at least not in developing countries - these people are extremely committed in most of the polio-infected areas that remain. However, when you look at a map of where polio is persisting in the world it is primarily in places where the public infrastructure in general is particularly weak. Thus the main problem that public health officials face is overcoming these broader weaknesses to achieve the level of programmatic perfection needed for eradication. A whole range of strategies, and incredible ingenuity, is used to overcome these barriers - new vaccines, GIS tracking of vaccinators, fingermarking with indelible ink, microplanning with community leaders, etc etc etc. Ironically the biggest difficulty we face with public health officials is in industrialized countries where such officials sometimes question the value of a global eradication effort!
  • Jul 21 2011: Hi Bruce, I heard your talk on TED an it was quite inspiring. I am a physician from India and studying epidemiology in the US. I have worked in the field and taken part in pulse polio immunization drives for many years. It feels so good to see that after so many years of hard work by all those concerned in this project, the end seems to be near. According to my experience, the three most important things towards achieving this goal are:

    1) Education and awareness: This according to me is most important. While conducting door-to-door immunization, I encountered many people who had misconceptions about the vaccine (Like the vaccine may make their child impotent, etc). Many people who were educated and knew that it was a live attenuated vaccine thought that it might give their child the disease instead of preventing it. Sporadic incidences of vaccine failures have not helped as well. I think more effort should be done towards educating the people, so that they will themselves come forward to get their children immunized. The right kind of education should be imparted to the right kind of people, like uneducated people should be explained in a different way than the educated masses.

    2) Maintenance of cold chain: If the cold chain is not maintained in the field, there is no use of all the awareness campaigns or spending millions of dollars on outreach activities. The field workers should be made aware of the importance of maintaining the cold chain. Again, from my experience as a field supervisor, I had encountered instances when the vaccine was not viable (as detected by the indicator) and was still present in the stock. Strict supervision is necessary.

    3) Governments should take the right initiatives and make polio as a priority. Many of the countries became polio free after governments decided that they want to eradicate this disease. Lack of government initiatives in african countries is one of the main reasons why polio still exists in Africa.
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      Jul 21 2011: Hi Parag,

      I agree with your views.

      But I do feel that 'Education and awareness' is not the panacea that we are looking for. 'Behavioural change' is the key. We just consider that education will automatically bring about desirable changes in behaviours. But this is not true.

      As you know, sanitation is a huge problem in India. Open-air-defecation is a very common practice. As you have rightly pointed out, many state government have taken the right initiatives by building community toilets. But these toilets are hardly ever used. Why has this simple and seemingly effective solution failed? The reason is 'cultural misfit' of this solution. We have to find effective modes of communication so that the right message is carried to the people. Miscommunication is the main reason why vaccine-related anxieties exist.

      Polio still exists due to its 'social epidemiological' links. Hence, I feel that the ultimate solution would have to be found in the 'society'.
  • Jul 21 2011: What is the most importnat thing that individual people can do to help the fight against polio?
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      Jul 21 2011: Amber, I think that there is much that you can do and that is available. Through your community either locally or via technology you can let your daily contacts know that this dreaded disease is so Close to being eradicated. Last year the case count worldwide was just over 900 cases worldwide and that there are now only 4 endemic countries. Those countries are Pakistan, Afghanistan, India and Nigeria. It is important to note though that migration patterns have reintroduced Polio to countries that have certified Polio Free.

      You can send a contribution as Bruce mentioned, by going to the following website. www.rotary.org/en/EndPolio/Pages/ridefault.aspxy

      Another was you can stay informed is to contact a Rotary Club and consider joining them in this worldwide.
      effort.
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    Jul 21 2011: First of all, governments agreed in 1988 that they wanted to eradicate polio. So everything else is details -- how to apply the proven and agreed strategies, which tools to use and when and where. Governments also approve the budgets associated with polio eradication, and that has to be agreed. They discuss and agree on statements of political commitment such as resolutions etc. Protecting children is something that people on all sides of the political debate agree on and is a neutral, global public good. The World Health Organization provides a forum for the international community to meet and flesh out these agreements.