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We've got polio on the run but, we need to seal the deal to
Polio is a disease you may know little or nothing about if you are lucky enough to live in a country where a successful immunization campaign has eradicated it.  You may never have personally met a person who contracted polio or have any idea what an iron lung is or looks like. (An iron lung performs the functions of a diaphragm when these muscles are too weak or paralyzed to allow a person to breathe.)  
Thanks to the unprecedented efforts of public and private organizations and millions of volunteers around the world, polio is a fading memory in North America and Europe.  In fact it is now endemic is only two countries - Afghanistan and Pakistan.  Rotary International and individual Rotarians have played key parts in the global campaign to eradicate polio. But close as we are to achieving the goal, we are not there yet.
The effort to eradicate polio is the largest public-private partnership ever to have been undertaken.  The organizational partners in this effort are:
  • Rotary International (RI)
  • World Health Organization (WHO)
  • United States Centers for Disease Control (US CDC)
  • United Nations Children's Fund (UNICEF)
  • The Bill and Melinda Gates Foundation
  • Governments in the countries where the fight against polio has been or is being waged
In addition, there is a global network of 20 million volunteers around the world who have vaccinated nearly 3 billion children over the last 20 years.
The Virus and How It Spreads
Poliomyelitis is a highly infectious viral disease.  It is transmitted from through contaminated water or food via a fecal-oral route, so is best able to spread where conditions of poor sanitation and weak health systems exist.  Children, particularly those under the age of 5, are most susceptible. Once ingested, the virus multiplies in the intestine and from there attacks the nervous system.  One in every 200 victims, the disease will cause variable degrees of paralysis, usually in the legs. When the muscles involved in breathing are attacked, poliomyelitis can cause death. In any case, the resulting paralysis is irreversible.  There is no cure for polio.  The only defense is immunization.
There are three strains of polio, none of which is viable outside a human host for very long.  If not transmitted to an unvaccinated person within a short time, the virus will die. The three types are distinguished by the protein shell, or capsid, which surrounds the RNA genome at the core of the virus.  The Type 2 polio virus was eradicated in 1999. Type 3, while still extant, is increasingly rare. Type 1 is the most prevalent strain. It is more paralytic and more easily transmitted that Type 3.  
Every Child Must Be Vaccinated - Every Single Child
Because polio can be devastating and because there is no cure, the only acceptable option is to eliminate it.  Because people travel, every child has to be immunized so that there is no host available anywhere in the world.  Unless this is accomplished, the ground that has been gained so far in this fight could be lost with as many as 1 million cases of polio happening within the next 40 years.
There are five types of immunization against polio - four types of oral polio vaccine (OPV) and the inactivated polio vaccine (IPV) or Salk vaccine.  Each of the vaccines has its advantages and disadvantages. 
OPVs, which contain live but weakened, wild polioviruses (WPV), are generally safe and highly effective and have been the first line of defense against polio. Monovalent versions of this type of vaccine provide immunity against Type 1 or Type 3.  A bivalent version provides protection against both Type 1 and Type 3.  One great advantage of OPVs is that they can be administered by volunteers, which allows for massive inoculation efforts. There are two main disadvantages:  In rare instances (1 in 2.7 million) paralysis can occur in recipients.  It is thought this might only occur in recipients whose immune systems are already compromised. The other disadvantage, because OPVs contain a live virus, is that rarely the virus may mutate and become a circulating vaccine-derived polio virus (cVDPV). 
The IPV (Salk vaccine) contains killed polioviruses of all three types, and is used in industrialized countries that have long been polio-free and where the risk of contracting polio from an OPV is deemed greater than the risk of importing a wild polio virus.  The IPV does not lend itself to massive immunization efforts as it must be administered by a trained health worker.  And the other disadvantage is that IPV, while providing immunity, does not stop transmission of the disease.  OPVs must be used to to contain polio outbreaks wherever they occur, as they were in the Netherlands in 1992.
If the effort to eradicate polio in all its forms is successful, the use of OPV will have to be discontinued due to the threat of live viruses mutating and becoming circulation vaccine-derived polio viruses.  At the point of complete eradication, all inoculation will be by IPV.
Progress So Far
There are now only 2 countries in which polio is endemic - Afghanistan and Pakistan.  On September 25th of this year, WHO certified Nigeria as Polio Free with no new cases of wild poliovirus having been reported for a full year.  It is a huge milestone because in 2012, more than half the new cases of polio reported were in Nigeria.
The Global Polio Eradication Initiative reports as of October 14, 2015:
  • In Lao People's Democratic Republic a circulating vaccine-derived poliovirus type 1 (cVDPV1) outbreak has been confirmed, with one case, an eight year old boy who had onset of paralysis on 7 September. Outbreaks of cVDPVs can arise in areas of low population immunity, emphasizing the importance of strong vaccination coverage.
  • Thirty five million children were reached with polio vaccines during the September campaigns in Pakistan. Nearly 3 million children who were previously missed were vaccinated during the catch up days following this campaign. ‘Continuous community-protected vaccination’ (community based vaccinators who carry out immunization activities on an ongoing basis) and health camps are helping to reach children in the most difficult to reach areas.

National Immunization Days
National Immunization Days (NIDs) are mass events organized to inoculate the greatest number of people against polio in the shortest amount of time.  They are widely publicized in advance of health workers and volunteers going door-to-door to contact families and immunize children. Those who have participated in NIDs often talk about their experience as being their life changing Rotary Moment.
The following statistics will give you an idea of the scope of an NID, but cannot convey the personal aspects — the sense of contributing to the greater good, the satisfaction of having participated in something so vitally important in protecting the children they meet from the scourge of polio.
When polio was still endemic in India, during a single NID:
  • 640,000 polio vaccination booths were erected
  • 2.3 million vaccinators were deployed
  • 200 million doses of vaccine were provided
  • 6.3 million ice packs were used to keep the vaccine cold
  • 191 million homes were visited
  • 172 million children were vaccinated 
Because the OPV contains a live virus, it must be transported in a temperature-controlled environment up until the time it is administered.  Insulated carriers and ice packs are provided to maintain this “cold chain.”  Once the vaccine is removed from the cold box, it must be administered quickly.
Each child vaccinated during an NID is given a dose of OPV and then has his or her pinkie finger dyed purple. 

Past 5240 District Governor Anil Garg, who has been leading NID trips to India since 1999, will lead another such trip to India next year, leaving 16 February and returning 28 February.  The trip will include meetings with staff from UNICEF, WHO and the Indian National Polio Office before participating in the NID on February 21st and February 22nd.  It will also include a trip to St. Stephens Hospital, which treats polio patients in Delhi and the opportunity to attend a Rotary meeting or visit local Rotary projects. Space is limited. Rotarians who are interested will find more information on the D5240 website.
Endgame Strategic Plan
The Polio Eradication and Endgame Strategic Plan, adopted in 2013 at the 66th World Health Assembly by PGEI established four objectives:
  • To detect and interrupt all polio virus transmission
  • To strengthen immunization systems and withdraw the oral polio vaccine
  • To contain the polioviruses and certify interruption of transmission
  • To plan polio’s legacy.
The first three are self-explanatory.  The last indicates the intent of those who have been involved in the PGEI that the robust network this initiative has built and the systems it has developed to track and respond to polio outbreaks will not disappear after polio is well and truly eradicated.  They will work to ensure that the operational lessons of this campaign are not lost and that what has been put in place can and will be used to respond to other public health issues.
Polio’s Other Legacies
Legacies such as the one planned by PGEI are positively welcome.  Post-polio syndrome is a legacy of another sort.  Years after an acute case of polio, survivors of acute polio cases can suffer from extreme fatigue, progressive muscle weakness or atrophy, and skeletal issues related to the muscular effects of polio. Though these rarely are life-threatening, they badly erode the sufferer’s quality of life.
As a polio survivor, District 5240 Polio Plus Chair Jim Lewis deals day-to-day with his personal polio legacy - the need to wear braces in order to stand and walk.  He is critically aware of the challenges that other polio survivors face and so is now in the process of developing Global Grants designed to address the lifetime effects of polio. Jim envisions a group of grants (funded by the Annual Projects Fund rather than by Polio Plus) that will provide for corrective surgeries, braces, wheel chairs, hand-operated tricycles, literacy training, vocational training, and job placement.   

District 5240 Fundraising Efforts
District 5240 members can take pride in their contributions to Polio Plus.  Between June 2014 and June 2015 alone, they contributed $200,574 to Polio Plus - near twice the amount contributed by any other Zone 26 district.  
Among the many D5240 members who have worked diligently raising funds for Polio Plus, Jim Lewis has been particularly active year after year.  At nearly every District event, Jim can be found in the exhibits area standing next to an iron lung and handing out information flyers. 
Among other fundraising efforts, D5240 is sponsoring Pedal Against Polio, which will take place in April 2016.  Anyone can participate from anywhere in the world by asking friends and acquaintances to sponsor their their ride and directing contributions to Polio Plus.  More information will be forthcoming on this and other events as it becomes available.
Paint Your Pinkie
Show your support for Polio Plus! If you are already immunized against polio, paint your pinkie purple, make a contribution to Polio Plus, take a selfie and we will post it.  
Every contribution, no matter how small, counts.  As little as 60 cents pays to immunize a child.  
Cook Something Up Good                    
Support Polio Plus while cooking up something good!  When you purchase the Rotarian Flavors of the World Cookbook from the Rotary Club of Long Grove (Illinois), $5 of the $15 purchase price will go to Polio Plus (shipping is included for US orders only).  The cookbook contains 400 recipes contributed by Rotarians in 150 countries.  For information on ordering email: or call 847.302.6310.
End Polio Now —
Polio Global Eradication Initiative —
World Health Organization —
D5240 Polio Plus Chair, Jim Lewis:
"Be a Gift to the World"
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