Six nations pledge to eradicate polio

PRETORIA -- The stakes of ridding the world of the polio virus rose significantly yesterday as health ministers from the last six countries where polio is still transmitted pledged to eradicate the disease by year's end.

Following a summit in Geneva, international officials said that reaching the goal was critical and that failure could doom the entire 15-year project to wipe out polio. They said every aspect of the job is growing tougher: Some donors have cut funding and shifted money into the war on terrorism, and political commitment among local leaders will almost surely falter if the intensive effort drags on for much longer.

"If we don't end the transmission of the wild polio virus by the end of 2004, we risk losing the $3 billion investment that has been spent already on eradicating polio," Pascal Villeneuve, UNICEF's chief of health, told reporters in a conference call from Geneva.

Already, officials have missed goals to eradicate polio by 2000 and 2002.

David Heymann, a special adviser on polio for the World Health Organization, said officials had offered to push back the deadline for eradication by a year, until 2005, but none of the countries involved wanted the delay.

Only one other disease affecting humans, smallpox, has ever been eradicated. The historic effort involving polio faces its toughest challenge in Nigeria, officials say. Heymann's statement, along with statements from the health ministers themselves, put the burden of success or failure squarely on the six countries, but no country will feel as much pressure as Nigeria.

Nigeria registered nearly 50 percent of world's new polio cases in 2003, and epidemiologists have determined that the breakdown in immunization in northern Nigeria led to transportation of the virus to seven nearby countries as well as heavily-populated areas around Lagos, in southern Nigeria.

Over the past several months, several Muslim leaders in northern Nigeria have raised concerns that either antifertility medicine or the HIV virus had been mixed with the polio vaccine. Their opposition crippled door-to-door immunization drives.

Several leaders in Nigeria's northern Kano state, the last major reservoir of polio in Africa, said in recent interviews that they would oppose further polio immunization because the United States helps fund the effort. Their opposition to America, they said, hardened following US wars in Afghanistan and Iraq, two Muslim nations. One leading opponent of polio immunizations, Datti Ahmad, could not be reached for comment last night in Kano.

But Nigeria's new health minister, Eyitayo Lambo, said yesterday he hopes to win widespread commitment for polio eradication in the next week, after meeting with Muslim leaders in the north and settling remaining concerns about the safety of the vaccine.

"We are very confident by the end of next week all their concerns will be addressed," Lambo told reporters. ". . . We are like generals in the army. . . . If we fight the battle together, we will win."

A diverse partnership has driven the effort to fight polio. It ranges from UNICEF and the WHO, to government agencies such as the US Centers for Disease Control, to a large private group, Rotary International. Rotary members have given tens of thousands of volunteer hours and raised more than $600 million. Its New England chapters, for instance, have collected hundreds of thousands of dollars.

But another $150 million is needed in the next two years to finish the job, WHO officials estimated. Many worry the money won't be available, because groups and governments are tiring of the cause and want to shift attention to other projects.

"I'm terrified. I've worried about the funds every single day," said Bruce Aylward, who has led WHO's polio effort. He said that a recent shortfall of $25 million shut down several projects.

Most critically, a shortage of funds over the last 18 months has forced the international team to focus almost solely on problem areas and not offer vaccinations to children in other countries. That strategy leaves millions of children unprotected in the event that polio spreads from the remaining six countries.

In addition to Nigeria, India, Pakistan, Afghanistan, Niger, and Eygpt are the countries where polio is still transmitted. Officials hope that Egypt will be removed from the list soon. India, which until this year provided the bulk of the cases, has made a remarkable turnaround and produced a dramatic reduction in transmission.

"We are not yet satisfied," said Prasanna K. Hota, secretary of family welfare in India's Ministry of Health and Family Welfare. "We want to proceed to zero transmissions."

All six countries have 11 months and two weeks to reach that goal. The ministers agreed to vaccinate 250 million children in that time, not once, but multiple times, in hopes of success.

John Donnelly can be reached at donnelly@globe.com.