Polio has been my top priority over a decade Atlanta Convention

To understand the true impact of the adage ‘He came, saw, overcame’, you had to be present in the huge hall at the Atlanta Convention in the mammoth Georgia World Congress Centre when Microsoft Founder Bill Gates held the audience in rapt attention and adulation. It took almost 20 minutes to reach the hall within the Centre, as you had to literally shuffle your way, one small step at a time, to reach the hall!

The huge assembly of Rotarians, representing almost every country in the world, hung on to every word Gates uttered, went into raptures of delight every time he praised Rotary’s work, particularly in polio eradication, which he did often, and burst into frequent bouts of thunderous applause.

Of course, Gates almost brought the house down when he announced that if Rotary sticks to its goal of raising $150 million over the next three years, he would match each dollar raised by two, and “together we will raise $450 million towards ensuring there is zero polio!”

And that $450 million would bring “the total amount raised by our partnership since 2007 to nearly $1.5 billion. That’s just amazing!” Add to this the support from Canada, Japan, the European Commission, UAE, etc and a whopping $1.2 billion were pledged to fight polio in the next three years.

Since 2000, over 10 billion doses of oral polio vaccine have been administered by an army of 20 million volunteers and a global team of thousands of frontline health workers.

However, Gates reminded the assembled Rotarians, money was only one part of the story of Rotary’s leadership on polio eradication, begun over 30 years ago. And since then, “in the face of challenges nobody could have predicted, you have kept it on the global agenda.” Both in the US and in the European capitals, Rotarians had insisted that the fight against polio gets the funding it deserves. In high-risk countries, they had ensured that government leaders kept their focus on polio eradication work.

Rotarian volunteers had done phenomenal work, he reiterated. Ann Lee Hussey, diagnosed with polio as a toddler, had led volunteers on some 25 trips to some of the most dangerous places on earth. Dr Yoshi Sekiba, a Japanese pediatrician, recently led a team of 60 Rotarians to Delhi — for the 16^th consecutive year. “And thousands of Rotarians in at-risk and endemic countries have spent countless hours immunising kids,” said Gates.

Building bridges

But more than anything else, Rotarians had built bridges when most needed. In the Ivory Coast, Marie-Irene Richmond-Ahoua, had acted when the new military leader had cancelled a National Immunisation Day in the midst of a coup. “She appealed, saying children should not suffer because of a conflict created by adults. And days later, the general presided over the opening of the rescheduled immunisation day!”

In Pakistan, Rotarians had helped overcome mistrust by working with Islamic scholars and religious leaders — who are now advocates for the polio programme. Also, Rotary had funded dozens of community centres and immunisation posts in high-risk areas and had worked with displaced people to explain the importance of polio vaccination. “These efforts have helped reduce polio in Pakistan from 306 cases in 2014 to just two cases so far this year.”

Single largest public health effort

It was a massive effort that had delivered such results; the Global Polio Eradication Initiative is the single most ambitious public health effort the world had ever undertaken, Gates said, adding, “we have gone from 125 endemic countries in 1988 to just three endemic countries today… and from 40 cases an hour 30 years ago, to less than 40 cases in all of 2016.”

To realise “how far we have come” on polio, it was imperative to look back. Not all that long ago, polio was everywhere. In 1994, the Americas were certified as polio-free, followed by the Western Pacific region (2000), Europe (2002), Southeast Asia, and India (2014). “This year, we are down to just a handful of cases in three countries: Pakistan, Nigeria and Afghanistan. The scale of this effort is phenomenal. Since the year 2000, more than 10 billion doses of oral polio vaccine have been administered by an army of 20 million volunteers, and a global team of thousands of frontline health workers,” he said.

But, added Gates, “the statistic that captures the impact the best is this one: more than 16 million people are walking today who would otherwise have been paralysed by polio.”

Working in areas of instability is extraordinarily challenging, and frontline health workers have risked and sacrificed their lives. And as quickly as progress is made, it can disappear.

Articulating the one question everybody is asking, Gates said while everybody wondered why it has taken so long, because the original plan was to be done with polio by 2000; “before I was even involved. And polio has been my top priority for a decade now. I think we’d all agree this has been harder than any of us expected.”

The answer lay in the ambition of the polio eradication programme; ensuring there were zero cases in a population of 7.5 billion people on the planet. “Across all 200 million square miles. No polio. That includes areas where there is war, countries where public health systems are virtually non-existent. It means reaching children in the most inaccessible places on earth — not just once but many times to ensure they’re protected.”

Persistence and innovation

Effusive in his praise for Rotary’s polio programme, the philanthropist said thanks to its “persistence and innovation”, Rotary had risen to the challenge, again and again. “It is this talent for generating new ideas, building on lessons learned, and adapting to new circumstances that makes me optimistic we will get to zero.”

The challenges were plenty but were being overcome one by one. In Afghanistan, despite the security challenges, most of the country remains polio-free, because the people running the programme there have helped build understanding that the only way to get rid of polio is to rise above political, religious and social divisions. “Working in areas of instability is extraordinarily challenging, and frontline health workers have risked and sacrificed their lives. And as quickly as progress is made, it can disappear. The detection of polio in Nigeria last year — after a gap of two years — was a reminder of how hard it is to eliminate the disease in conflict areas. Fortunately, the Nigerian government responded swiftly.”

Another challenge was parents refusing to have their children immunised because of fear or misunderstanding. But in Nigeria, Afghanistan and Pakistan, efforts to engage traditional and religious leaders had made a big difference.

Polio warriors

Giving examples, Gates said the Emir of Kano, one of Northern Nigeria’s most prominent traditional leaders, had once consumed an entire vial of vaccine to reassure people that it was safe!

Five days a week, Fiaz Bibi, a vaccinator in Pakistan, covers herself with a burqa, walks three miles to a dispensary to pick up supplies, and makes her rounds to the 105 families in her community. “Temperatures can exceed 110 deg F, and Fiaz often feels the disapproving eyes of villagers following her. Yet, she persists — visiting every nook and cranny of her village — because she believes it is her ‘moral duty’ to make sure every child is protected against polio.”

Success had come by mapping the regions where children had not been vaccinated in some countries. But a big challenge was finding the last vestiges of the virus; with fewer and fewer cases of polio, this was most difficult; “to stop the virus completely, we have to know where it is still hiding.” There were two ways to do this; by examining the stools of paralysed children to see if they have polio. And, to look for it in sewage systems, especially in high-risk areas.

Nigeria’s quick response to Ebola

But the huge cadre of trained health workers, armed with vital data, that the polio programme had created, now have the expertise to provide critical health services to the most vulnerable people. The outbreak of Ebola in West Africa had proved it. Though it tragically killed more than 11,000 people, mainly in Guinea, Liberia, and Sierra Leone, the death toll would have been much greater if quick action by polio workers hadn’t stopped the disease from spreading in neighbouring Nigeria, Gates said.

As soon as they realised that a few cases had spread to Lagos, the “polio workers jumped into action. They set up an emergency operations centre to coordinate efforts, tracked hundreds of people who had come in contact with Ebola patients, and deployed community volunteers to get out the message on how to stay safe.” Their efforts prevented a much bigger tragedy.

“This is what is so exciting about Rotary’s 30-year fight. Not only are you eradicating one of the worst diseases in history. You also are helping the poorest countries provide their citizens with better health and a better future. And getting to zero is incredibly inspiring as an achievement of humanity.”

In the midst of pessimism that things are getting worse from bad, the progress on polio is a “reminder of what people can accomplish when they are bold, determined and willing to work together,” Gates said.

Effusive praise for Rotary

Giving Rotarians their due for the relentless hard work they had put towards eradicating polio, Gates said, “When the story of polio eradication is written, it will be about millions of individuals linking arms and persevering in the face of innumerable setbacks. Rotary laid the foundation with its unwavering sense of purpose and its belief that anything is possible if you put your mind and body to it.”

But, he cautioned the 40,000-odd delegates assembled in Atlanta, that “we aren’t quite ready to write that story yet. To be certain that polio is eliminated, we have to maintain vaccination rates at a very high level. And even when we get to zero, we have to go three years without a single new case. There is no other option, because if we fail, polio will return to the countries where it has been eliminated — and it will kill or paralyse hundreds of thousands of children a year.”

But they would have to keep reminding their government that the fight wasn’t yet over.

Pointing to the silver lining in the cloud, Gates said that our world was getting to be a better place. “People are living longer, healthier lives. Extreme poverty is below 10 per cent. We eradicated smallpox. These are astonishing achievements, and when we add the end of polio to the list — which I’m certain we will — it will be another triumph for humankind. It also will be a testament to the compassion, generosity and kindness of more than a million Rotarians around the world. You are the people who are making it possible to get to zero. And that will be something worth celebrating.”