September 20, 2021 1:15pm – 2:15pm Madelon Finkel, Ph.D. Defining and Measuring Global Health/Global Burden of Diseases Location: Griffis Lounge
Speaker: Madelon Finkel, Ph.D. Date: September 20, 2021 Time: 1:15pm to 2:15pm Location: Griffis Lounge Title: Defining and Measuring Global Health/Global Burden of Diseases
Summary: This session will discuss how one goes about measuring and evaluating burden of disease. Eradication of polio in India will be used as an example. Students will be asked to answer specific questions pertinent to running the polio eradication campaign, including strategies to increase rates of vaccination to lower transmission rates.
Suggested Readings: John TJ, Vashishtha VM. Eradicating poliomyelitis: India's journey from hyperendemic to polio-free status. Indian J Med Res. 2013; 137(5):881-894. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3734678/
Background: Polio vaccines have helped to eliminate the virus in almost all countries of the world. As of 2016, Nigeria, Pakistan, and Afghanistan are the only remaining countries that are not polio-free (NOTE: the novel coronavirus, SARS-CoV-2, pandemic of 2020-2021 most likely disrupted immunizations globally, leading to a resurgence in diseases for which we have vaccines, polio included). In 1978, the Expanded Programme on Immunization (EPI) was adopted by India, which, at the time, accounted for half of the world’s polio burden. In 1979, the trivalent oral poliovirus vaccine (tOPV) was introduced in India. The tOPV protects against the three serotypes of poliovirus and is administered orally, without the need for trained health professionals, sterile settings or syringes. Between 1978 and 1982, 104 million children were immunized with DPT (a combination vaccine against diphtheria, tetanus, and polio). And 4.1 million with three doses of the tOPV. However, due to the low immunogenic efficacy of tOPV, the number of polio cases reported in vaccinated children skyrocketed. By the early 1990s, polio was still hyper-endemic in India with 200,000 to 400,000 cases reported annually. In 1997, the National Polio Surveillance Project (NPSP), a joint initiative of the World Health Organization and India, was launched. The Pulse Polio Immunization (PPI) program was launched by the Indian government, which improved polio surveillance and enabled poliovirus transmission to be quickly detected anywhere in India. In 1997, 73% of Indian babies had received the oral polio vaccine. The World Health Organization declared that India had successfully eliminated polio in March 2014. If you were running the polio eradication campaign in India over the past decades: • Describe the strategy you would use to mount the eradication campaign. How would you have organized and administered the campaign (e.g., in the beginning phases). • What barriers/challenges would you have had to take into consideration before mounting the vaccination campaign? • What data would you have needed to assess need and to monitor the program? • How would you have taken into account differences in polio rates among the 29 States and 7 Union Territories within India? • What strategies would you have implemented to increase the rates of vaccination and to lower transmission rates in the country? • How would you have evaluated success (or failure) of your campaign?
Please understand that the Indian government did not achieve polio elimination on its own. There was close collaboration between the government, non-governmental organizations (e.g., Rotary International, WHO, UNICEF, Indian Academy of Pediatrics, and the Bill and Melinda Gates Foundation), the public and private health sectors in India, and the general population. The NPSP remains the hallmark of India’s current prevention strategy. Given that India shares a long porous border with Pakistan where polio has not been eradicated, there is concern that polio could be reintroduced into India despite all the efforts to have eliminated the virus in that country.
Session Evaluation Please fill out this evaluation form after class.