By all intent, 2006 is supposed to be the golden year to make a final declaration of achieving total eradication of poliomyelitis termed 'The Crippling Disease'. However, as we are saying goodbye to 2006 and planning for 2007, that expected declaration would not be possible.

The polio virus has remained very stubborn and tough at least in Africa and Asia where in some countries, it is still endemic. This thesis aims to look at lessons learned, challenges of implementation as well as proffer recommendations toward realistic goals in dealing with the menace of poliomyelitis. "In 1988, polio paralysed nearly 1000 children everyday worldwide. The world embarked that year on a programme to eradicate the polio virus, which cripples permanently. By 2000, fewer than a thousand children had been paralysed in the entire year. Today, 18 years after its inception, the Global Polio Eradication Initiative has reduced cases of polio by 99% and spared five million children from paralysis.........The G8 countries have contributed over half the US$4 billion spent to date.

The G8 first placed polio eradication on its agenda during its summit in Kananaskis, Canada, in 2002 and has renewed its commitment to eradication at every summit since then. G8 countries work as a group to not only raise financial contributions, but also to advocate with others to support eradication. If and when polio is eradicated, it will be only the second disease that humans have stamped out after smallpox." (http://www.who.int/mediacentre/events/2006/g8summit/polio/en/).

In her presentation titled 'Finishing the Global Fight against Polio (October 10, 2006 ) at the Elliott School of International Affairs of The George Washington University, Dr Paula Dobriansky, United States Undersecretary for Democracy and Global Affairs highlighted some challenges of Polio Eradication as follows: "Today, polio is endemic in four nations-Afghanistan, India, Nigeria, and Pakistan. The populations affected by polio in those countries are among the poorest and most difficult to reach through public health tools such as vaccines, communication campaigns or trained health workers. Existing conflict, dire poverty, and religious and social tensions have compounded the problems. Setbacks have resulted in the exportation of polio infections from affected areas to countries where wild polio had been eliminated, threatening to turn back the progress we have made.

Completing the task of eliminating polio requires commitment, cooperation, and community involvement. Diplomatic initiatives must complement and reinforce public health actions. First, the international community must renew and strengthen its commitment. We must fight what may be fatigue, waning enthusiasm, and decreased financial support among some donors. To achieve these objectives, we use bilateral and multilateral fora to continue to highlight the importance of polio eradication, including exchanges such as the G-8 Summit where we strive to ensure the support of world leaders. We urge other groups, such as the Organization of Islamic Conference to do the same, and they have. And we are actively working with leaders in polio-endemic countries and with international and regional organizations to encourage sustained action in polio-affected regions. U.S. financial support-both from private donors and from the government-remains strong. Yet, vaccination campaigns and emergency operations in outbreak areas continue to face funding gaps. While many nations have given generously, other potential donors have yet to fulfil their pledges, or have not given at all.

This administration will work with our partners to ensure that resources become available." As the US Undersecretary mentioned that "We must fight what may be fatigue, waning enthusiasm, and decreased financial support among some donors," it is true we need to fight donor fatigue, but apart from that, we need to focus also on community fatigue and apathy. Communities are over-consulted and visited during polio immunisation days over the last years, which has become ritual in the four countries with polio endemic. If we lose their confidence, then the campaign will not be successful. Other equally important problems creating setbacks are corruption, bad governance and inept leadership. While polio vaccines are reaching children at their doorsteps free of charge, side-by-side with that, leaders of those countries have failed to provide basic primary healthcare services and routine immunisation and provision of clean water that led to a lot of suspicion, boycott and apathy among communities. Also, the huge amount of resources budgeted for immunisation days by local authorities, federal governments, international development partners and donor governments cannot be adequately and properly accounted for by the implementers of the programme.

In essence, the financial resources the US Undersecretary is talking about are not being used judiciously for polio eradication. These are valid challenges that must be addressed if meaningful progress is expected. According to Global Alliance for Vaccines and Immunisation (GAVI), a public-private partnership focused on increasing children's access to vaccines in poor countries, there is "the inability of the poorest countries to provide vaccines for all of their children. Roughly, one child in four does not receive any vaccinations.

Of the 130 million children born each year, two to three million will die from vaccine-preventable diseases." GAVI went on to say that "Measles kills an estimated 745,000 people, most of whom are children, worldwide each year and also causes permanent disabilities for some of its survivors, including blindness, deafness and brain damage. Complications of the disease are much more common in low-income countries, and in malnourished children, than in industrialised countries.......... Today, about 5000 people, mostly children, die of diphtheria each year ........ Each year, about 286 000 people, almost all young infants, are killed by pertussis (whooping cough) worldwide, and at least 45 million suffer from the illness with prolonged and exhausting bouts of coughing that may continue for up to three months. Some children also suffer seizures and neurological damage........ There are an estimated 201000 deaths from neonatal tetanus each year. However, the total number of tetanus deaths is much greater because mothers, older children and others can also be affected. WHO estimates that there are some 281000 deaths altogether each year (http://www.gavialliance.org/general_information/immunization_informa/diseases_vaccines/vaccine_preventable_deaths php)".

Based on the opinion of many child activists worldwide, polio can be effectively eradicated through routine immunisation which has almost collapsed in many developing countries. Not only will routine immunisation achieve polio eradication, strengthening such services will address all the above-mentioned vaccine preventable diseases effectively. Overall, that will provide the necessary synergy for the protection, development and survival of children to actualise their full potentials. In conclusion, one will advocate for a shift in health policy from eradicating polio through immunisation days to polio eradication through routine immunisation. Let the disease surveillance and social mobilisation continue and the financial resources of immunisation days which reportedly most of it is not being spent on the work used to provide primary healthcare services in communities to enable routine immunisation to function very well. Another component to be added is to create community monitors, a kind of volunteers within the communities who shall be supported, trained and monitored by existing health NGOs.

They should provide the following services: Serve as link with the polio surveillance team to report suspected cases; Engage other members of the community through dialogue on the importance of immunisation; Help those who have just given birth with information on where to access vaccine; · Keep records of families with children below the age of five years to ensure compliance. Going by this strategy, if followed very well, the world will hopefully and enthusiastically achieve polio eradication by the end of 2008. Dr Magashi is a master's degree student (Public Health) at London School of Hygiene and Tropical Medicine. He is also a director with Community Health and Research Initiative, Kano, Nigeria. He can be reached at gamagashi@gmail.com.