TRF Tagung 2008 POLIO und ROTARY

Was ist Polio (1) Virus Infektion mit RNA Picornaviren 3 Typen, keine Kreuzimmunität Fäkal-orale Übertragung unter Menschen Typ 1 + 3 noch existent Typ 2 seit 1999 nicht mehr nachweisbar

Was ist Polio (2) 95% - 99% stumme Infektionen nur max. 1% manifest, davon 5 – 10% Todesfälle keine medikamentöse Behandlung nur Vorbeugung = Impfung (oral, i.m.)

Polio 1988 Polio 2007 / 2008 Endemisch in 125 Staaten 350 000 Erkrankungen p.a., > 20 000 Todesfälle Polio 2007 / 2008 >99% Reduktion der Erkrankungen = >1300, 5% Todesfälle Endemisch in 4 Staaten : Afghanistan, Indien, Nigerien, Pakistan Re-Infektionen in 6 Staaten durch Virusimport: Chad, Congo, Niger Sudan, Myanmar, Nepal 2007: Impfung v. 400Mio Kindern, 2,3 Mrd.Dosen, 27 Staaten, 0,6 US $ p. Dosis

Political & societal buy-in Very efficient transmission Risks at end-2006 4 parts of 4 countries were 'stuck' 2 of the 4 countries had re-infected 27 others Int'l spread of polio from India & Nigeria, 2003-7 Active conflict Autonomous areas Political & societal buy-in Very efficient transmission Remaining endemic countries as of 2002

Major Barriers at Feb 2007 Technical: inability to interrupt poliovirus despite very high coverage (i.e. northern India). Financial: inability to maintain US$700 million/year expenditure due to limited progress. Operational: chronic failure to reach >90% of children in parts of all 4 endemic areas.

Type 1 Polio Cases at 1 July 2008 Endemic countries Wild virus type 1 New importations (2008) Persistent imports (2006-7)

Type 3 Polio Cases at 1 July 2008 Endemic countries Wild virus type 3 New importations (2008) Persistent imports (2006-7)

Financial Contributions since 1988: US$ 6 Financial Contributions since 1988: US$ 6.38 billion and Funding Gap for 2008-2009 G8 51% Domestic Resources 13% Multilateral Sector 14% Non-G8 OECD/ Other 5% 2008-9 Funding Gap: US$ 355m of $1.36b budget Private Sector 17% ‘Other’ includes: the Governments of Angola, Austria, Australia, Azerbaijan, Belgium, Brunei, Czech Republic, Cyprus, Finland, Hungary, Iceland, Ireland, Kuwait, Liechtenstein, Luxembourg, Malaysia, Malta, Monaco, Namibia, New Zealand, Nigeria, Oman, Pakistan, Portugal, Qatar, Republic of Korea, Saudi Arabia, Singapore, Spain, Switzerland, Turkey, the United Arab Emirates; African Development Bank; AG Fund; American Red Cross; De Beers, Inter-American Development Bank, Central Emergency Response Fund (CERF), International Federation of Red Cross and Red Crescent Societies, Oil for Food Programme, OPEC Fund, Sanofi Pasteur; Saudi Arabian Red Crescent Society, Smith Kline Biologicals, UNICEF National Committees, UNICEF Regular and Other Resources, United Arab Emirates Red Crescent Society, WHO Regular Budget and Wyeth.

Polio Ausrottung – 2013 erreichbar? Dzt. 179 Staaten ( 86% ) von 206 Staaten als poliofrei zertifiziert Erforderliche Mittel 700,0 Mio US$ p.a. Notwendige Begleitmassnahmen : Überwachung, Laborkontrollen, Lager mit mOPV und IPV Harvard-Studie: bei vorzeitigem Impfstopp vielfache Kosten in 10 Jahren!

Polio Eradication – Prospects Asia: on track to stop type 1 polio in 2008. <15 cases in each country. no indigenous type 1 for >12 months in UP, India. all type 1 outbreaks stopped. Africa: type 1 will be delayed > 12 mos. >300 cases in north Nigeria. 8 countries have ongoing outbreaks. Chad, DRC, Niger & SUD/ETH outbreaks >24 mos.

(average number of OPV doses = 4 vs. >8). BUT….it is still biologically 'easier' to eradicate polio in Africa than in Asia (average number of OPV doses = 4 vs. >8).

India: stop Type 1 transmission Nigeria: <15% missed children Key Landmarks at June 2008 India: stop Type 1 transmission on track Nigeria: <15% missed children not on track

DG Intensification – June 2008 (1) Establishing as 'WHO's top operational priority' directive to all ADGs during June retreat. discussed with RD/AFRO. wrote to all RDs & WRs of endemic & re-infected countries. Enhancing partner commitments discussed with heads of UNICEF, CDC & Rotary. conducted joint press conference. Encouraging resource mobilization helped launch Rotary's US$100 m Challenge. promoted as top priority during Gates Foundation mtgs. G8 advocacy.

DG Intensification – June 2008 (2) Addressing Nigeria situation wrote to Presidents of Nigeria, Niger and African Union. met & discussed with UN Secretary-General. requested 4 G8 Heads of State to discuss at Summit. requesting follow-up with President at UN in September. Encouraging India: wrote to CM UP on new importation. writing follow-up to CM Bihar in advance of flood season. Pakistan & Afghanistan: writing to new Prime Minister following 'emergency' TAG. evaluating options to improve SIA security in conflict areas.

Leistungen von Rotary 1985 – 1988 Anfangsinitiativen 240 Mio US $ 1988 Partnerschaft mit WHO, UNICEF und CDC - 2008 Rotary Beiträge 750 Mio US $ und hands-on Leistungen BMGF 100 Mio US $ Rotary-Challenge weitere 100 Mio US $ - 2010 Rotary Zusage belastet jeden Club mit ca. 3300.- in 3 Jahren

Leistungen D 1910 & D 1920 Bis 2007 1,16 Mio US $ 2008 – 2010 bereits beschlossen D 1910 € 25.- p.a./ Mitglied (BIH € 15.- ) D 1920 € 18.- p.a./Mitglied D 1910 – A € 90 000.- p.a. gesamt € 270 000.- Nicht-A € 45 000.- p.a. gesamt € 135 000.- . D 1920 – A € 55 000.- p.a. gesamt € 165 000.- zu erwartende Gesamtleistung mind. € 570 000.- !!! zusätzlich : Clubaktivitäten & freiwillige Spendenaktionen

Barrieren für Polio-Aktionen Impfmüdigkeit „Konkurrenzkrankheiten“ wie Aids, Malaria, TBC etc. in Industriestaaten Polio nicht mehr „sichtbar“ (zu)lange Dauer der Aktion Versprechung „Eradication“ sehr hoch gegriffen, besser . „Stop the transmission“!

Trotzdem, oder gerade deswegen „Alt“ Rotarier dürfen jetzt nicht müde werden! „Jung“ Rotarier müssen motiviert werden und finanziell beitragen generell „ Awareness – Bewusstsein“ schaffen und verstärken Partnerschaft-Gründer Rotary darf jetzt nicht „aussteigen“, denn . „mitgefangen-mitgehangen“