Immunization Coverage and Surveillance: Challenges for the Poliomyelitis Global Eradication Initiative

In May 1988 the Forty-first World Health Assembly committed WHO to the global eradication of poliomyelitis by the year 2000 (Resolution WHA41.28). Global eradication, as has been achieved for smallpox, can be defined as the complete and permanent cessation of the natural transmission of an infectious-disease agent. The broad objectives of the global poliomyelitis eradication initiative are to achieve, by the year 2000, no case of clinical poliomyelitis associated with wild poliovirus, and no wild poliovirus identified worldwide through sampling of communities and the environment. Global poliomyelitis eradication will be highly beneficial. Apart from the huge benefit associated with the control of the disease - more than 200,000 cases of paralytic poliomyelitis are estimated to occur each year - the main cost savings for all countries, developed as well as developing, would be provided by abandoning poliomyelitis immunization. In the United States alone, the expected savings are estimated to be $114 million per year. However, because of the epidemiological features of poliomyelitis, all control efforts directed at the disease can be dropped only when worldwide eradication has been achieved and certified. Two of the main problems to solve before global eradication can be realized are how to implement and maintain a) high-coverage immunization programs and b) effective surveillance systems all over the world. The purpose of this paper is to review the progress and the remaining problems in these two key areas.Master of Public Healt