Polio and Health Systems

(Boy in an iron lung, a treatment for polio paralysis, in 1955. Photo credit: otisarchives4)

The fact that polio still exists is a testament to just how hard it is to successfully vaccinate children. We've had effective vaccines since 1955, but there were still 1,652 cases of polio in 2008. Under two thousand cases doesn't sound like that many, but polio is highly contagious. Outbreaks spread fast.  And the 2008 number was actually higher than the 2007 number - we only saw 1,315 cases of polio in 2007.

So, why haven't we eradicated polio yet? Part of it is about polio's specific characteristics as a virus. Multiple vaccinations are needed for full protection from the polio viruses.

The largest part of the challenge, however, is just the challenge of childhood vaccinations. It takes a lot of health system effort to provide childhood vaccinations, both in terms of cost and in terms of time and capacity.

In order to immunize a population, you need health care providers who know how to provide vaccinations. You need a sufficient supply of vaccines, syringes, and a distribution system to get them to the providers. You need a way to keep the vaccines cold, and therefore effective, until they are given. You need access to children - either by going to them, or having them come to a health facility. You also need parental permission for the vaccination.

All of those health system factors tie into larger structural concerns. Parental permission is dependent on faith in the health system, which depends on faith in government. A cold chain requires safe and reliable travel. Health care providers need to get paid. That's a lot of points for failure.

It's those points of failure that have kept us from eradicating polio.