Rotary International Convention 2010 - Dr. Bruce Aylward, PhD

Dr. Bruce Aylward is a Canadian physician and epidemiologist, heading the Global Polio Eradication Initiative (GPEI) since 1998.

From 1992 to 1997, Aylward worked with national immunization programs at the field level in the Middle East, Western Pacific, Europe, North Africa, and Central and Southeast Asia.  In 1998, he was appointed GPEI director, responsible for the oversight and coordination of all eradication activities across the World Health Organization’s regional offices and the GPEI partnership.

Under Aylward’s oversight and management, the GPEI expanded to operate in every country of the world, the number of polio-funded staff deployed by WHO grew to over 3,500 worldwide, and new monovalent and bivalent oral poliovirus vaccines (mOPVs) were developed for the program.

Plenary Session Address:

Eight months ago, I received this letter from President John and Chair Glenn, inviting me to tell 20 000 Rotarians, from all over the world, about progress toward polio eradication.   As I looked out the window of my office on that bleak, grey day in Geneva, with their letter in my hand, I wondered whether I would face those 20 000 Rotarians with good news or bad news.

President John, Chairman Glenn, ladies and gentlemen, I don’t have bad news.  I don’t have good news.  I have terrific news.

For the first time in history, polio is truly on the run from its last strongholds.  For the first time in history, in India six months have passed without a single child in Uttar Pradesh or Bihar being paralyzed by the more dangerous of the two remaining types of polio.  And for the first time in history, in Nigeria there has been a 99 percent drop in polio cases, collapsing from over 300 paralyzed children at this point in 2009 to just 3 so far this year.  Rotarians, this is the moment you have been waiting for.  This is your chance to secure your place in history.

Ladies and gentlemen, this is exciting news indeed.  But as you leave this convention, you will still hear tough questions about the robustness of this progress, and hushed whispers expressing doubts.  So let’s be very clear about the outright transformation that we have seen in the PolioPlus program over the past two years.

To set the stage, we first have to go back 25 years, to 1985 when Rotary vowed to vaccinate every child against this disease.  Polio was roaming virtually unchecked across the developing world, with over 125 countries infected.  Every two minutes another child was painfully and permanently paralyzed by polio.

In one of the greatest public health triumphs ever, Rotary and its partners spearheaded and unprecedented international effort that completely eradicated one of the three types of polio and eliminated the others from all but four countries of the world: India, Nigeria, Pakistan, and Afghanistan.

But this virus, which has plagued the human race for millennia, was not to be conquered so easily.  It retreated into conservative, underserved, and often remote communities, where parents did not trust outside vaccinators.  It retreated behind the front lines of active conflicts, where vaccination teams risked their lives to reach children.  It retreated into riverine areas, where raging floods could put millions of people beyond the reach of health care workers.

It was from these last reservoirs, particularly in Northern Nigeria and Northern India, that the virus dug in and mounted a vicious counteroffensive.  By 2004, polio was again spreading internationally, taking advantage of the weakest health care systems of the world to explode in new epidemics and demoralize millions of volunteers who had worked for decades to eradicate it.

Twenty-four months ago, 192 ministers of health gathered in Geneva and raised an international alarm over the stalled progress in the last four countries to eradicate polio.  The ministers empowered the director-general of the World Health Organization, Dr. Margaret Chan, to take whatever steps were needed to finish the job.  One month later, Dr. Chan stood on a stage like this one and announced that she was making polio eradication our top operational priority on an urgent basis.  The very next day, we—Rotary, WHO, and our partners—started to rewrite the polio eradication playbook.  Everywhere, Rotarians were at the centre of the work to transform PolioPlus.

In India, Rotarians worked with partners and the chief minister of Bihar State to mobilize hundreds of additional health workers and thousands of extra volunteers to vaccinate the millions of children living in the Kosi River flood plains and urban slums, where the virus was hanging on due to the complete absence of the most basic of health services.

In Nigeria, Rotarians teamed up with a new minister of health to recruit the governor of every state to ensure that the supply side of the vaccination campaigns worked and that the polio vaccine actually got to communities.  Nigerian Rotarians then enlisted the traditional leaders, with their deep historical roots in those communities, to ensure the demand side of the equation was in place.

In the rough and tumble world of the Afghanistan-Pakistan border, Rotarians built permanent shelters so that vaccination teams could work year round to immunize the thousands of children crossing that border and thereby stop the regular reinfection of each side.

These are just a few examples, but you get the picture – this recent progress is the work of Rotary and the work of Rotarians.  You have fundamentally changed the polio eradication game, and you have changed it in your favour.

Ladies and gentlemen, as we worked side-by-side to ensure that every child was vaccinated in the villages, the slums, and the cities, we also worked in the laboratory to refine our eradication tools over the last 24 months.

We had to make absolutely sure that given the Herculean effort Rotarians were making to reach every child with a polio vaccine, they had the best possible chance of protecting that child from polio.

So last year we embarked on PolioPlus’s own “Manhattan Project” and tested not one, not two, but four new vaccines and vaccination approaches for use in the PolioPlus program.  Making vaccines is a high-stakes game, with many failures littering the path to every success.  But we only needed one of these new vaccines or approaches to work.

Exactly 12 months ago, we received the preliminary results of our first study.  As the results rolled off the printer, we learned that we had hit gold.  In June 2009, we learned our new “bivalent” vaccine, which targets the last two types of poliovirus in the world, worked almost twice as well as the old poliovirus vaccine, massively simplifying the logistics of the PolioPlus program while boosting its impact enormously.

The new vaccine was rushed into production in the middle of last year, and by December the first doses were being given to children in Afghanistan.  The cross-border immunization posts that Rotary had set up were some of the first places to use this new vaccine.  Since January 2010, every time a Rotarian vaccinates a child with the new bivalent OPV, there is a 50 percent higher chance that the child will be protected and that he or she will be protected against both of the remaining polioviruses.  Fifteen years ago, we were told that a vaccine like this could not be made.  Today, it is at the centre of a new PolioPlus plan.  This is the power of Rotary’s vision.

Ladies and gentlemen, you are now reaching more children than any other health or development program ever has.  You have better vaccines than at any other point in the PolioPlus program.  You have the world’s leaders behind you like never before.  And you have less polio, in fewer places, than ever in history.

But you will still hear questions and doubts as you champion the Rotary challenge to End Polio Now.  Why should we finish eradication?  Now that there is so little polio in the world, isn’t it better to switch to a control program and do something else?  Can’t this money be spent elsewhere?

Twenty-five years ago, Dr. Albert Sabin, the inventor of the oral polio vaccine, shared the stage with Rotary leadership at a convention like this one, and spelled out the consequences of failing to launch PolioPlus.  Dr. Sabin informed the Rotarians present that if they did not act, at least one million more children would be paralyzed by the time Rotary celebrated its 100^th birthday.

The stakes are now much higher, because in the last 12 months you have proven, without a doubt, that polio can be eradicated.  The world has also learned the full consequences of failure.  If we do not act now and end polio, once and for all, nearly 20 million more children will be paralyzed by the time this great organization, Rotary International, celebrates its next centenary.

The roaring polio outbreak we have seen this year in Tajikistan, a country that had been polio-free for over a decade, stands a stark reminder as to the consequences of global fatigue in this battle.  Three hundred children have already been paralyzed in Tajikistan.  Adults have died.  Borders have been closed.  Travel has been banned.  Trains have sat idle on their railways for nearly two months.

Polio is a dreadful, devastating disease.  We finally have the means and know-how to banish it everywhere, forever.

Polio eradication is expensive, but it is a very good value for the money, given the sheer scale of this global eradication effort.  This is a program that reaches over 500 million children, year after year, for less than 25 cents each.  This is a program with a vaccine that can prevent a lifetime of disability for just over 10 cents a dose.  And this is a program that will deliver tens of billions of dollars in net benefits, to the poorest countries of the world, within 20 years.

And look at the impact of your generosity!  Look at what your PolioPlus dollars have achieved, in just the last 12 remarkable months of this program:

• The Horn of Africa outbreak was stopped in record time last year because PolioPlus funds put and army of workers on the ground
• Presidents and prime ministers in 19 African countries kicked off the largest polio campaigns in history, because PolioPlus funds were available
• In India, the most dangerous poliovirus has not been seen for six months in Uttar Pradesh and Bihar, because PolioPlus funds paid for a legion of external monitors
• In Afghanistan and Pakistan, the new bivalent vaccine was used for the first time, because PolioPlus funds trained thousands of volunteer vaccinators
• In Tajikistan, Europe’s most explosive polio outbreak in history is stopping, because PolioPlus emergency funds were released within 48 hours
• In Nigeria, polio cases plummeted by 99 percent this year, because PolioPlus funds underwrote their polio campaigns

This unprecedented progress is due to you, Rotarians.  When anyone looks at those maps, they are looking at the work, and the generosity, of 1.2 million Rotarians.  When anyone looks at those maps, they will understand why Rotary’s $200 Million Challenge is critical to the success of polio eradication.  PolioPlus is still the best buy in town, but the real pay-off can only be realized when polio eradication is completed.

Ladies and gentlemen, to eradicate a disease we must reach every last child, everywhere, irrespective of race, creed, culture, geography, or even conflict.  Eradication is the great equalizer.  It is the ultimate in social justice and equity.

Your decision, 25 long years ago, to protect all of the world’s children from polio, was more than a decision to eradicate a dreadful disease.  It was a decision to challenge the world to change the course of history and ensure every last child, everywhere, could hope for a better tomorrow.

Your decision, your work, and your generosity have inspired the world.  You have been the heart and the soul of the largest global health effort in history.  You have been the conscience that is driving us to keep our promise to the world’s children.  You have truly put Service Above Self.  And you have truly put Rotary on the world’s stage.

Polio is an ancient disease.  It has plagued humanity for thousands of years.  You, Rotary, have brought it to the brink of eradication.  You must not let polio claw its way back from the brink now.

Ladies and gentlemen, polio can be eradicated if you leave this convention armed with the facts about polio and if you carry these facts to the 1.2 million Rotarians in 33 000 clubs around the world.  Tell the Rotary world the facts: you have terrific news.  Polio is on the run.  Your vision of a polio-free world is truly in sight.

Ladies and gentlemen, Rotarians have done the extraordinary in the pursuit of polio eradication.  Accept the Rotary challenge and End Polio Now.