Polio Eradication

Photo from washingtonpost.com (Hosam Katan/Reuters) 

Photo from washingtonpost.com (Hosam Katan/Reuters) 

Ever since we worked with Middlebury College professor Svea Closser to make maps for her research on the impact of polio vaccination campaigns on routine immunizations and primary health care delivery in 2012, we’ve been following along closely with the international developments related to polio eradication. This week, we were excited to see an encouraging report on Syrian polio eradication efforts in the Washington Post from friend and fellow Middlebury alum Tik Root.

Of special interest to us in Tik’s report, was the incredible scale and collaborative nature of the recent campaign successes. This past October, Syria confirmed its first case of polio since 1999.  And the response has been remarkable. During the fall, a group of small, Syria-oriented nonprofits formed an ad-hoc Polio Control Task Force, bringing together dozens of organizations, from local groups to foreign governments, and even SAMS, the opposition-linked Assistance Coordination Unit. They rapidly recruited thousands of almost exclusively Syrian-based volunteers, provided training, and set up a complex network of distribution centers. Their use of local people allowed them to secure virtually unprecedented cooperation from rebel fighters, and though the work is far from done (especially in the regime-controlled areas of the country), about 1.4 million children have been vaccinated since the start of the year.

Map from the washingtonpost.com, October 2013

Map from the washingtonpost.com, October 2013

While the complex ecosystem of actors and politics in Syria is definitely unique, there are real lessons to be learned here for the development community. In fact, this sort of collaboration is something that Professor Closser has been calling for in her research for years. In her book, “Chasing Polio in Pakistan,” she argues that, if what has becomes the world’s largest eradication effort in history is to succeed, we need to replace top-down, centralized command chains with partnerships, and push governments to truly back small-scale, local agencies and health workers. 

In Pakistan, despite the efforts of tens of thousands of health workers, political violence and lack of substantial government support have stymied the push for eradication. Unlike in Syria, immunizers in Pakistan have not only repeatedly struggled to gain access to areas of the country controlled by rebel groups, but have also been the target of fatal attacks themselves — with more than 30 deaths in the last two years. Militants remain deeply suspicious of the vaccination campaigns, believing that they are a cover for spies or western plot to sterilize Muslim children, and some local leaders have halted efforts altogether.

Concerns are mounting about the opportunities for increased transmission as the refugee crisis along the border with Afghanistan continues to grow. According to the Global Polio Eradication Initiative, Pakistan will remain unable to interrupt transmission without “radical change” in the northwest of the country. The WHO also recently named Peshawar as the “largest reservoir of endemic polio virus in the world,” calling for full political commitment and support for the vaccination teams.

Map from the Global Polio Eradication Initiative 

Map from the Global Polio Eradication Initiative 

So, while the development world has continued to call on governments and international aid organizations to step up efforts — with the WHO Director-General declaring polio a public health emergency of international concern this past May — we were happy to see that they have also begun to reach out to the GIS community.

The Global Polio Eradication Initiative will be front and center at the Esri User Conference next month. Dr. Vincent Seaman, senior program officer for the Polio Country Support Team at the Bill & Melinda Gates Foundation, and Dr. Bruce Aylward, assistant director-general for the WHO’s Polio and Emergencies cluster, will speak about their work at the conference’s Opening Session to an estimated audience of 16,000.

Among the topics they are expected to cover is the important role maps have played in identifying areas of greatest need and helping target resources. As former mappers on a Gates-funded project, we are especially interested to hear what Dr. Seaman will share on how the foundation’s polio program is currently using maps and spatial analysis in high-risk areas to both enhance and assess effectiveness.

This is a map that we made for Svea Closser's research study. More maps here, in the supplementary data section of her recently published article.

This is a map that we made for Svea Closser's research study. More maps here, in the supplementary data section of her recently published article.

So many of the obstacles faced by decision-makers in the fight against polio are inherently spatial problems. Like many of the organizations we work with, success is dependent on the decentralized, door-to-door efforts of community health workers and local managers. Already complex logistics are made more challenging by poor infrastructure and refrigerated vaccines. And “high risk” or “target population” can be defined not only by age, but also by a number of demographic and geographic factors. Maps have a key role to play in facilitating this process, and we hope to see this conversation become an increasingly central one in the context of eradication.