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Smallpox has been globally eradicated since 1980, so why is the eradication of Polio so much more difficult? The World Health Organization (WHO) recently released that the Global Polio Eradication Initiative (GPEI) would be conducting a new targeted 15 country effort to vaccinate 72 million children in Africa. The new campaign follows numerous failed efforts of the past and reemerging outbreaks. Why does the African continent remain prone to Polio outbreaks that spread rapidly? Why did the organized campaign to eradicate Smallpox take only 21 years while Polio is going on almost 40 years?

Since 1796, when cowpox was used to protect humans from Smallpox, eradication efforts have taken place. It wasn’t until the WHO intensified the eradication of smallpox in 1967 that efforts were coordinated around the world. The Smallpox Eradication Program (SEP) was jointly run by the WHO, CDC, and National Ministries of Health in various countries. Doctors and epidemiologists from the US volunteered to help with the efforts. In many instances US volunteers were overbearing and controlling of their local counterparts. A report by Paul Greenough documented the use of intimidation and coercion in the final stages of the SEP. Foreign volunteers were sent to kick down doors (literally), force vaccination of those who refused, and fix the mistakes of local staff members (1995). These coercive tactics evoked resistance from local communities, but the SEP prevailed. The SEP was run in a structured, militant fashion, where individual human rights were overridden for the global public good. Similar issues with resistance have been seen in Polio eradication efforts, but responses to resistance have not been as militant. Could this be why Polio has continued to resurface?

The earliest documented case of Polio in Africa is traced back to 1580 B.C. in Egypt and still the virus continues to spread across the continent. The eradication of Polio relies heavily on National Immunization Days (NIDs), but these events are ineffective because they aren’t comprehensive vaccination efforts, positive cases are missed and some children aren’t vaccinated causing continued Polio outbreaks. Organized Polio eradication efforts began when the World Health Assembly launched the Expanded Programme on Immunization (EPI) in 1974, a program implemented through the NIDs . In 1988, the World Health Assembly said that by the year 2000 Polio would be eradicated and they launched the Global Polio Eradication Initiative (GPEI) to make it happen. Many prominent people and organizations put their support behind the program including Rotary International and Nelson Mandela, who in 1996 launched the “Kick Polio Out of Africa” campaign which vaccinated 420 million children. In the 90s, the UN Secretary General negotiated peace treaties to vaccinate in war-torn Liberia and Sierra Leone. Most recently in 2004, 23 African countries coordinated NIDs focused on Polio vaccination.

After all these efforts, Africa remains the only continent where Polio remains alive and well in multiple countries. A series of studies completed across West Africa showed that due to misconceptions about the vaccine, lack of adequate funding and corruption at the local level, and ineffective immunization campaigns, Polio has persisted on the African continent (Melissa Leach & James Fairhead, 2007). The year 2007 marked an outbreak of 25 cases in Angola which spread to 28 cases in the Democratic Republic of the Congo (DRC). In 2008, after an outbreak in northern Nigeria, where there have been vaccination conspiracy theories, spread to a dozen other countries, the WHO made Polio eradication their “top operational priority.”

Armed with a “more effective” version of the oral vaccine, the new GPEI organized effort across 15 countries hopes to eradicate Polio for good. However, just yesterday the New York Times wrote that the WHO reported 104 deaths and 201 cases of paralysis from Polio in the DRC. Is the renewed GPEI effort, launched Oct. 28, 2010, even working? Is eradication even a desirable goal at all, if past experience with Smallpox Eradication Program requires militancy?

Crossposted from the Americans for Informed Democracy Blog where I am writing as a Global Health Analyst.

Health has long been a gift that we have attempted to give to the rest of the world. Disease eradication programs, vaccination outreach campaigns, and the Western biomedical system have all been spread to countries near and far. These gifts were often colonialist in design, given without community consent, and without regard to culture or custom. Contrary to Thomas Friedman‘s thoughts, the world is not flat. Rather we live in a world that is increasingly connected by technology, but still remains sharply separated by those who have and those who don’t.

When it comes to global health, we no longer have the luxury of saying, “those people over there have health issues.” There is no simple separation between “us” and “them.” Health problems aren’t over there any more than they are right here. In the US, lifestyle choices contribute to heart disease, diabetes, obesity, and lung cancer. When we talk of disparities in access health in other parts of the world, we cannot forget the glaring health disparities in US inner cities and across communities of color.

The curtain has been lifted and hopefully we have looked in the mirror to see that we too have health issues in our country. While the ideas to make health better have long come from the West and developed countries, that paradigm is no longer applicable to global health today. Our world is still expansive, but we are more connected than ever before. With the internet at our finger tips and friends across the ocean only a skype call away, solutions in global health come from around the world. The past demonstrated that “developed” countries believed they were giving something valuable to those who didn’t have what they had. The result was a plethora of failed aid goals, missing life-saving medications, and decrepit health care systems.

Innovations for better health come from all around the world. It is no longer the “developed” giving ideas to the “developing.” The increasing use of mobile phones have inspired some exciting programs for health records management while SMS and texting have led to revolutions in access to health knowledge and care. However, it isn’t always technology ideas that are most effective. Developing countries have reminded us how important and critical health insurance can be, while at the same time demonstrating the severe need for more trained health care workers. Models that train community health workers, access micro-health insurance on your mobile phone, and social enterprises that provide ambulance emergency services have all been launched in “developing” countries. I can only hope that our health care system can take the time to look around the world for ways to improve.

For many years, complex issues in international development and global health have been tackled by simplified single-issue campaigns that have created short-term “band-aid” solutions. This can be attributed to the limited view most Americans have of the world. For many, issues of global health remain remote and abstract. We, young people, have grown up with the internet in our laps, basic knowledge of different cultures around the world in our classrooms, access to easier communications and travel, and more opportunities to study abroad and participate in global exchanges. These factors have made the world seem more connected, and have bestowed upon us the capability to serve as the key drivers of social change.

We must bridge the divide between rich and poor, privileged and oppressed, developed and developing. We, as privileged young people, can be the voice that changes the actions of our largest institutions to focus on programs that work, projects that benefit people in need, and efforts to build healthier communities.

Reposted from the Blog of Americans for Informed Democracy, where I am writing as a Global Health Issue Analyst.

Recent cholera outbreaks in earthquake-stricken Haiti, a flooded Benin, and the newest natural disasters in Indonesia beg the question: what can be done when natural disasters are the cause of health problems in developing nations?  While cholera has long been a disease most people see as irrelevant and outdated, new cases have sprung up in both nations and disease will most likely threaten Indonesia in the near future.

In rural Haiti, cholera took the lives of 150 people, and several worry that the disease will spread into a full-on epidemic if it makes its way to the densely populated capital, Port-au-Prince. Despite media and supposed aid agency attention there are reports that cholera has spread to the Artibonite Valley, three hours away from Port-au-Prince.

Benin faces a similar threat. Cholera is threatening the already precarious health situation in the country, following the “worst flooding in the last forty years.” A World Health Organization (WHO) official said, “…the disease risk is imminent and means solid epidemiologic surveillance will be paramount.” As multiple natural disasters hit Indonesia, including an earthquake, tsunami and volcanic eruption disease and health concerns will be an inevitable issue.

What should aid agencies be doing to combat health issues brought on by an erratic, unpredictable and blameless force? How should nations, NGOs, and other agencies help prevent the spread of completely preventable and treatable diseases that threaten to kill thousands?

(Photo Credit: Amazon)

History has set African health care up for failure. Lack of trained health workers places a massive burden on many African health care systems, inadequate or non-existent infrastructures make provision of basic needs like food and water impossible, debt and limited budgets move health care to a lower financial priority, medications are expensive and multinational pharmaceuticals want to make big profits, colonialism, apartheid, neo-colonialism, and the effects of an oppressed history perpetuate inadequacies in health care.

The varied record of health in Africa over the past century is inseparable from the history of change in control over political institutions and change in the organization of economic production. In the early years of colonial rule some governments relied on forced labor; in parts of colonial Africa, especially in the eastern and southern parts of the continent, male workers migrated from rural homes, leaving their families behind; in the postcolonial years class differentiation has become more pronounced, with some workers permanently separated from their roots in the countryside.[1]

Feierman and Janzen are right on target again in describing the scene of African health in relation to colonialism, politics, and history. African countries inherited health care systems from colonial authorities, but very often there was no health workforce to fill the void of colonial medical professionals. One Frenchman wrote,

La suele excuse de la colonisation c’est la medecin [the only excuse for colonialism is the doctor] – Hubert Lyantey (1926)[2]

If nothing else colonization was a positive in establishing health care systems and providing professional doctors? I wish I could agree, but mission societies that often ran health services relied on negative images of Africans.[3] The famed Dr. Livingstone was a doctor with the London Missionary Society and is best known for his explorations of the continent that allowed colonial empires to penetrate further into and conquer the African interior.

The slow demise of colonization did not end Western interference in Africa. Well into the 1980s and 1990s some African populations remained under the oppressive control of Western and minority populations. This control led directly to the ill health of those populations, notable South Africa and Mozambique. Black South Africans were denied basic health care services, training, and other needs.[4] South Africa fought a proxy war in Mozambique that specifically targeted the destruction of health care infrastructures. In African countries that gained earlier independence there were other powers to face.

[...] the IMF and World Bank have much to answer for. [Their] policies have eroded Africa’s health care systems and intensified the poverty of Africa’s people. – Salih  Booker[5]

Structural Adjustment Programs (SAPs) and other policies forced by Western institutions made the development from colonialism to independence that much more difficult for African countries. As Hunter writes, these policies often increased the poverty of African populations as opposed to providing for their basic needs. Health became a lower priority as African countries fell into debt because of loans from the IMF and SAPs of the World Bank. Even today with the economic recession African governments are cutting their health budgets to make ends meet. Health services should be the last item cut from a budget as health is central to all other human development.

Health is a major issue in Africa as the basic needs becoming increasingly difficult to provide and there have already been numerous reforms and attempted mechanisms to provide adequate health care.

[2] Hunter, 136.

[3] Ibid, 144.

[4] Hill, 6.

[5] Hunter, 47.