ERADICATION PROGRAMS

As of 2013, eight global eradication

programs for infectious diseases had
been attempted. Of these, only the
smallpox and rinderpest programs
had succeeded. The eradication
programs for dracunculiasis, polio,
and yaws were ongoing, and three
programs malaria, hookworm, and
yellow fever had been uncontrolled.
 Eradication of Smallpox

Smallpox is an infectious disease caused by the variola minor and variola major
viruses. Smallpox infects the small blood vessels of the skin, mouth, and throat,
resulting in a blistering rash, blindness, and sometimes death.

INDICATORS OF SMALLPOX ERADICABILITY

Humans were the only reservoir for the disease, so if human-to-human

transmission could be eradicated there would be no further disease circulation.

Practical diagnostic tools were available to aid in the confirmation of smallpox

cases.

Transmission of the disease did not occur during the incubation period, before the

arrival of symptoms.

Invisible cases did not exist, that is, all people with smallpox revealed

symptoms.
 CHALLENGES WITH SMALLPOX
ERADICATION
lack of organization in national health services

smallpox epidemics among refugees fleeing conflict

periodic shortages of vaccines

number of problems that resulted from difficult climate and

territory and resistant cultural beliefs

But perhaps the most significant challenge was funding. While

the United States contributed more than any other country, it
was reluctant to pay the full cost given that the benefits of
eradication were shared internationally
 Eradication strategy
The two-pronged eradication strategy proved extremely successful, and by 1975
smallpox remained only in the Horn of Africa

Conditions of civil war and scarcity in Ethiopia and Somalia made eradication
efforts extremely difficult in those areas, and when it was thought that the last
outbreak had been controlled, the disease resurfaced in the southern part of
Somalia

WHO officially certified that smallpox had been eradicated on December 9, 1979.
In 1980 the World Health Assembly recommended that countries stop routine
vaccinations

The global benefits of eradication were estimated to be approximately $1.35

billion annually. These benefits included the savings associated with vaccination
costs that would have been necessary in the case of control rather than
eradication as well as outbreak control and health services costs. The benefit to
the United States alone was estimated at $150 million annually in avoided
vaccination costs.
 ERADICATION OF
DISEASES
Eradication of Rinderpest

Eradication of Dracunculiasis
(Guinea Worm Disease)

Eradication of Malaria
CHALLENGES RELATED TO POLIO
VIRUS
INVISIBLE INFECT IONS
Subclinical poliovirus infections do not present symptoms and are thus
unidentifiable. Given that every infected person regardless of symptom
presentation defecates and thus spreads the virus, the occurrence of subclinical
or invisible cases makes surveillance and containment extremely difficult

VACCINE-DERIVED POLIO AND VACCINATION REGIMEN

While the OPV has proved extremely effective in mass immunization campaigns, it
also has a number of drawbacks. The vaccine contains a live virus and in rare
cases can lead to vaccine- associated paralytic polio and the circulation of
vaccine-derived poliovirus

POLIT ICS AND LEADERSHIP

The killing of more than twenty polio healthcare workers in Pakistan and Nigeria
during late 2012 and early 2013 was considered by many observers to be a
significant setback to eradication efforts in the last three polio-endemic countries.
Despite these challenges, the political will to fight polio remained strong in
Afghanistan, Pakistan, and Nigeria. Each country developed targeted action plans
to eliminate polio.
 CHALLENGES RELATED TO
PAKISTAN
Pakistans polio eradication campaign
Pakistans polio eradication program has
come under international scrutiny due to its
position as the main driver of global wild
poliovirus spread in recent years. This is
rooted in financial and organizational deficits,
as well as active conflict and insecurity,
which has resulted in the persistent failure of
effective immunization campaigns and SIAs
to reach all areas of the country.
Poor management and operational deficits
With less than 2 % of the Gross National Product
(GNP) spent on healthcare, an adequate health
infrastructure and service delivery system is
severely lacking in many parts of the country.
Concerns regarding OPV efficacy
Frequent power outages and the scarcity of
equipment in Pakistan have made it difficult to
maintain the cold chain necessary for OPV efficacy,
and has contributed to the alarming rise of cVDPVs
as well as wild poliovirus-induced poliomyelitis
among vaccinated children
Negative propaganda against vaccination
A concerted propaganda campaign by militants
operating from the Pakistan-Afghanistan border
region, and supported by some religious clerics, has
spun a narrative linking vaccination programs to a
Vaccine hesitancy
Parental refusal is a significant hindrance to the vaccination
campaign due to misconceptions regarding the purpose or
effectiveness of immunization such as the widespread
misconception that vaccines can harm or sterilize children, or
contain monkey- or pig-derived products which is forbidden in Islam

Cultural issues
the presence of all-male vaccinator teams when the mother is
alone, or when family or community elders have not given consent
for vaccination have also been cited as important barriers to
immunization in some communities

Vaccination bans and security concerns

The Taliban-imposed ban on vaccination in 2012 has been
detrimental to polio eradication efforts, especially in parts of FATA
where more than 350,000 children remained unvaccinated for more
than 2 years