your connection to The Boston Globe

Officials expect to complete plan today to eradicate polio

Urgent meeting of WHO backed by Harvard study

A health worker vaccinated an Indonesian child against polio after a measles immunization yesterday in Jakarta. (Photo by Dimas Ardian/Getty Images)

WASHINGTON -- The final push toward global eradication of polio has been full of pitfalls, but those fighting the disease expect to finalize a plan today that they believe should wipe out the virus.

Backed by a new Harvard analysis that details the high costs of failure, an urgent World Health Organization meeting will bring together donors, infectious disease experts, and representatives of the last countries in which polio is still transmitted -- Nigeria, India, Pakistan, and Afghanistan.

Spurred by doubts on whether polio can be eradicated , public health officials have debated whether to continue the 18-year effort to kill the disease, or to simply control outbreaks of it. The WHO, under director-general Margaret Chan has decided to continue toward eradication, and the new plan depends on the four countries' leaders to commit to it -- and intensify programs to vaccinate children.

In India, for instance, volunteers in the states of Uttar Pradesh and Bihar in January began to give oral polio vaccines to nearly 20 million children every month until July -- instead of giving vaccinations every three months. In northern Nigeria, polio vaccination days now include distributions of vitamin A, deworming pills, and antimalaria bed nets.

Even if the eradication drive makes headway, a major hurdle awaits: vaccinating children along the Pakistan-Afghanistan border, a dangerous stretch where several Al Qaeda leaders may be hiding out. Two weeks ago, a senior Pakistani health official involved in polio immunization died in a bombing in the Bajaur tribal area; it was not clear whether he was targeted because of his polio work.

"There are several challenges in different parts of the world, and that is why this meeting is timely," said Paula Dobriansky , US undersecretary of state for democracy and global affairs, who will attend the Geneva meeting. "We need to come together to strategize and establish some benchmarks. We are very committed to the global goal of eradicating polio."

R. Bruce Aylward , the WHO polio coordinator, said that the polio virus "has humbled us over the last few years" and heads of state must join the eradication effort. "We can't predict when the virus will disappear, but we can say what it will take to get it to disappear in these areas."

So far, smallpox is the only eradicated disease that had affected humans. In 2001, the fight against polio seemed promising, with just 483 cases reported globally, but the disease has surged, with nearly 2,000 cases reported in each of the last two years.

Nigeria has become polio's epicenter since 2003, registering 1,116 cases last year, 56 percent of the world's total. India reported 672 cases last year, 10 times more than it recorded in 2005.

The eradication program still needs an estimated $575 million for the next two years, and the United States -- which saw a record 52,000 cases of polio in 1952, yet wiped out the disease by 1979 -- is the leading donor. It has given $1.2 billion since 1988, including an anticipated $132 million this year.

Kimberly Thompson , a Harvard School of Public Health associate professor and director of the Kids Risk Project , will present preliminary findings today from a study that compares the costs of eradication with managing future polio outbreaks.

Thompson said the early conclusions were similar to her study of polio vaccinations in the United States. In that published report, she found that US vaccinations over a 50-year period resulted in a savings of $180 billion, including what would have been the cost of treating an estimated 1.1 million cases of paralytic polio and more than 160,000 deaths.

"What has been good in the US also is good for people around the world," Thompson said.

Dr. Bob Scott of Rotary International's antipolio campaign, said he believes managing outbreaks would result in a "huge number of cases again." He said "we are going to have to push [Nigeria, India, Pakistan, and Afghanistan] to get the job done."

John Donnelly can be reached at