Monday, November 10, 2008

Volunteers and Vaccines: A Look at Polio and its Path to Eradication on a Global Level

In its two-decade long campaign to eradicate polio from the world, the World Health Organization has already reached and immunized over a billion children in both advanced and underdeveloped countries. If it succeeds, it will be the single greatest accomplishment of mankind. However, during the summer of 2003, a young boy in a rural town in southern India contracted the virus. With the potential for a massive epidemic, the WHO responded with a budget of billions and the help of hundreds of thousands of volunteers to halt the spread of an outbreak.

Polio occurs almost exclusively in children under five. Ruthlessly tough and adaptable, the virus can survive more than sixty days outside the body—and in places with poor sanitation, it spreads quickly and unopposed. This, coupled with the fact that Polio is extremely hard to identify in its early stages, makes the disease a huge concern among public health officials. “With every person that becomes paralyzed, between two hundred and one thousand people show little more than flu-like symptoms, and remain silently contagious for weeks while the symptoms abate”. Multiple rounds of vaccination are therefore required, especially in children who often contract diarrhea and pass the medication straight through. So when a boy from the southern Indian state of Karnataka contracted symptoms, it triggered a giant bleep on the radar screens of Indian medical officials.

In less than 24 hours after the case had been reported to higher authority in first Mumbai, and then New Delhi, both the World Health Organization and UNICEF were notified and key people alerted. Technicians in WHO began constructing a mop-up plan. A “mop-up” is a “targeted campaign to immunize all susceptible children surrounding a new [outbreak]”. This particular mop-up needed to cover fifty-thousand square miles in a time period of no more than three days in order to immunize the population effectively, and also to recruit the most volunteers. And to add complexity to an already daunting task, coverage of less than 90% of the target population was considered a failure. The budget plan included the following in order to vaccinate approximately 4.2 million children:

• 37,000 volunteers
• 4,000 supervisors
• 2,000 vehicles
• 18,000 insulated vaccine carriers

Amazingly, WHO hires no vaccinators and doesn’t distribute vaccines. It only organizes a plan and then distributes the necessary funds, leaving UNICEF to supply the vaccines. Government health officials (who possess no affiliation with WHO or
UNICEF) then must recruit, train, and distribute the legions of volunteers. Local health officials finally face the task of reaching thousands of people scattered over hundreds of miles by organizing and budgeting a micro-plan to divvy up and cover their individual districts.

What it really came down to in order to execute the massive undertaking was hard work and dedication from thousands of volunteers. During the three days, UNICEF personnel distributed over five-million doses of the frozen vaccine for the mop-up. Hundreds of thousands of banners and handbills were printed and posted by Rotary of India, and public service announcements looped constantly. It took diligence and numbers, as well as readily available supplies, transportation, and medicine. After the fourth day, the mop-up was deemed a success, yet the WHO’s mission wasn’t over. Officials were able to continue where they left off before the outbreak occurred, working day in and day out to ensure a complete eradication of the virus.

Works Cited
Gawande, A. (2007). Better. New York: Picador.

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