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How ending polio in Africa has had positive spin-offs for public health

Polio is a highly infectious disease. It’s caused by a virus that enters the body through the mouth. The virus then multiplies in the intestine and attacks the central nervous system — causing paralysis. Polio was one of the most dreaded diseases in the world in the 20th century. Four decades ago, an estimated 350 000 people were paralysed each year by the poliovirus in more than 125 countries. This led the World Health Assembly in 1988 to adopt a resolution for the worldwide eradication of polio, drawing inspiration from the eradication of smallpox. The global programme to eradicate polio is spearheaded by a number of actors. These include national governments, the World Health Organisation (WHO), multiple development agencies, and healthcare workers. The strategy involves widespread vaccination as part of routine healthcare services as well as mass vaccination campaigns. Sensitive surveillance to detect and rapidly respond to polio cases is also key. This initiative has been extremely successful. The number of people paralysed by polio decreased by 99,9% — from 350 000 in 1988 to 175 in 2019. During the same period, the number of polio endemic countries fell from more than 125 to only two: Afghanistan and Pakistan. A country is endemic when there’s widespread circulation of polio. The latest WHO region to be certified polio free is Africa. The region was certified on August 25, 2020. The certification came four years after the last case of poliovirus on the continent. The polio eradication programme in Africa directly combated a severe debilitating disease. But it also provided a platform for broader healthcare services on the continent. Polio eradication created renewed demand for vaccination services and innovative ways to deliver healthcare services. What does it take to eradicate a disease? It takes a combination of multiple biological and non-biological factors to eradicate a disease. Only one disease, smallpox, has so far been eradicated. Polio viruses only survive for a very short time in the environment and there are no animal or insect reservoirs that carry polio viruses. More importantly, effective vaccines exist against polio. Beyond these biological features of polio, the eradication of polio from Africa required sound leadership. In 1996 African heads of state resolved to stamp polio out of Africa. Then South African President Nelson Mandela launched the “Kick Polio out of Africa” campaign. Thereafter, all-of-society collaborations supporting widespread polio vaccination sprang up across African countries. These involved government departments, the private sector, the civil society, and the community at large to ensure eradication of polio from the continent. Within national governments in Africa, public service departments worked across portfolio boundaries, formally and informally, to achieve the shared goal of polio eradication. All these efforts culminated, 14 years later, in the certification of the eradication of polio from Africa. Certification is based on evidence that something has been achiev

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