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Endgame for Polio?

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Rukshar Khatoon, from Sahapara, Howrah District, West Bengal, has joined Saiban Bibi, a Bangladeshi beggar living on a platform of the railway station at Karimganj, Assam, and an unnamed cow grazing in Tamil Nadu, as markers of the success of vaccination programmes in India, successes which confounded all the critics. Rukshar was 18 months old when she developed paralytic polio in January 2011. Saiban was 30 when she developed smallpox on 24 May 1975. The Tamil Nadu cow developed rinderpest in September 1995. All three diseases are now extinct in India.

The last person to be infected by smallpox by natural transmission was Ali Maow Maalin, a hospital cook in Merca, Somalia, who developed his rash on 26 October 1977. He recovered and later worked for the WHO’s polio eradication programme. Six months ago, on 22 July 2013, he died of malaria.

The last outbreak of rinderpest was in wild buffalo in the Meru National Park, Kenya, in September 2001, and global freedom from it was declared in June 2011. The nastiness of smallpox and polio are well known. For cattle, rinderpest – closely related to measles – is often even worse, with mortality rates more than 90 per cent. Epidemics have caused famines.

Polio still hangs on. Cases are few, but in 2013 the Pakistan variety still circulated in North Waziristan and Afghanistan (and was found in Gaza and Israel); the Nigerian variety occurred in Cameroon; the virus had an epicentre in Banadir in Somalia and occurred in Kenya and Ethiopia; and it caused paralytic cases in Syria, the first since 1999. In all these places there are conflicts, local bans on immunisation, or both.

If only it were possible to follow the Indian example: mass pulse vaccination of 170 million children in each round with the help of 2.4 million vaccinators. Ghulam Nabi Azad, the Indian health minister, announced yesterday that there have been no reported cases of polio in India for three years. The WHO will endorse India’s polio-free status in March. Azad said it was ‘one of the greatest things to have happened in this country’. He’s right.

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