Extract

This issue of the Journal contains an important contribution to the effort to rid the world of polio—an article that measures the effectiveness of oral polio vaccine (OPV) in reducing poliovirus excretion in northern India [1]. Its importance lies in its shifting of attention from measures of protection against disease to measures of protection against infection transmission in the field, a shift that is essential if the eradication program is to succeed

The Global Polio Eradication Initiative faces major challenges. Now 9 years beyond its original target date (the year 2000, set by the World Health Assembly in 1988), the initiative has been unable to stop wild-virus transmission in 4 countries (Afghanistan, Pakistan, Nigeria, and India), and these countries continue to export wild virus to other regions of the world. The problems are clear: in Afghanistan, Pakistan, and Nigeria, it is largely failure to vaccinate; in India, it appears to be vaccine failure. The failure to vaccinate in Afghanistan and Pakistan is largely a consequence of political instability and security difficulties that hamper program activities, adding another misfortune to the many serious problems in that troubled region. In Nigeria, the low coverage is due to program failure, aggravated by low public confidence and insufficient political will in the face of unfounded rumors that polio vaccine is unsafe. Resolution of these problems is proving difficult, but at least they do not challenge the technical feasibility of the eradication goal. The situation in India is different and more serious—wild virus has continued to circulate despite the most intensive vaccination program ever conducted

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