‘The Final Inch’: Real ‘Oscar’ would be polio’s global eradication!

Not longer just a drop in the ocean...
No longer just a drop in the ocean..?
The Final Inch didn’t win the Oscar for the best short documentary film made in 2008. But the nomination has given a boost to the film and its cause: even before its official release in April 2009, it is already raising global awareness on the major public health challenge of banishing polio from the planet.

The Final Inch is a testament of the health workers around the world laboring to make polio the second globally eliminated disease behind small pox, says director Irene Taylor Brodsky.

The 37-minute film, due to air on HBO on 1 April 2009, looks at the “the final stages of a 20 year initiative” to eradicate polio. It focuses the polio vaccine efforts in India and Pakistan, which are among the last four countries where polio is still endemic (the other two being Afghanistan and Nigeria).

Watch the trailer for The Final Inch:

The campaign to eradicate polio is now 21 years old. World Health Organisation (WHO), UNICEF and Rotary Foundation embarked on this campaign in earnest in 1988, and as a young (and equally earnest) science journalist, I remember writing about its early strategies, goals and targets. But the virus has proven to be a lot more stubborn than originally expected.

Well, the campaign has scored remarkable victories, and a little over 1,600 people in the world were stricken by polio in 2008. (AIDS and malaria, in contrast, killed more than three million people.) Compare that with 350,000 cases per year when the global onslaught started, and we see there has indeed been progress.

But the virus – and the crippling disease it causes – persists in several poor, densely populated countries in Asia and Africa. Updates are available from Global Polio Eradication Initiative.

Thus it’s the ‘last inch’ – or last mile, if you like – that’s proving the hardest to traverse. In a perceptive essay published in Newsweek in January 2009, Fred Guterl noted: “It’s not easy to wipe a disease off the face of the planet—especially one like polio, which spreads easily and quickly through contact and occasionally through contaminated food and water. Only one in 200 children who contract the virus shows symptoms (usually paralysis), which makes the other 199 silent carriers.”

It’s not just biology that polio eradicators are up against. Indeed, human superstition and religious dogma have made the final inch particularly contentious and treacherous for public health workers.

In 2005, TVE Asia Pacific started distributing a global documentary on immunisation called Fragile Lives: Immunization at Risk. It showed how at least 2 million children die every year from diseases that that vaccination could easily prevent.

Foot soldiers of the largest non-military army in history engaged in its final battle
Foot soldiers of the largest non-military army in history engaged in its final battle
At one point, the film takes us to Uttar Pradesh, in northern India, to show how polio, eradicated in most of the world, stubbornly persists in a few countries. This very poor state with its 272 million inhabitants had two thirds of the world’s polio. We talk to the glamorous young cricketer, Mohamed Kaif, who helps publicise a massive campaign to get every single child to the vaccination booths. The film discovers the strange reason behind why so many Muslim parents refuse to have their children vaccinated.

The Final Inch features the heroic efforts of Munzareen Fatima, a field worker in Meerut, Uttar Pradesh, who is a part of UNICEF’s Social Mobilisation Network for ensuring vaccination coverage. She reaches out to her target group through personal and public intervention programmes.

As she told IANS: “It has been a tough journey for me over the last five years to convince 470 families at Dufferin block in Khairnagar to administer polio drops to their children. I met with resistance from the families, who initially refused to immunise their children. The conservative community also belittled me for stepping out of home to campaign against polio.”

India is not alone. If anything, misplaced resistance to polio vaccination has been stronger in Pakistan. As IPS reported in August 2006, the country’s drive against polio was hit by both rumours and litigation.

The news story, filed by Ashfaq Yusufzai in Peshawar, noted: “The reliability and safety of oral polio vaccine (OPV) has been put under scrutiny in Pakistan after wild rumours that it causes impotency snowballed into a writ petition in a high court.”

Bill Gates: geek power and bucks to battle polio...
Bill Gates: geek power and bucks to battle polio...
Religion-inspired superstitions have often stood in the way of achieving sufficient vaccination coverage, leaving room for viruses to spread again. Religious leaders sometimes strengthen the hand of those making pseudoscientific claims, says South African science writer George Claassen. Writing in SciDev.Net in April 2008, he noted: “Attempts to eliminate polio in Nigeria, for example, ran into problems when Datti Ahmed, the chair of the Supreme Council for Sharia in Kano state, referred to the Global Polio Eradication Initiative as ‘modern-day Hitlers… who have deliberately adulterated the oral polio vaccines with antifertility drugs and contaminated them with certain viruses which are known to cause HIV and AIDS.'”

This brings up an interesting scenario of virus vs. virus. Richard Dawkins, the well known British evolutionary biologist and writer, has called religion the most malevolent form of a ‘mind virus’. According to Dawkins, faith − belief that is not based on evidence − is one of the world’s great evils. He claims it to be analogous to the smallpox virus, though more difficult to eradicate.

Of course, the mistrust of vaccines is not just limited to the developing world, nor is it always inspired by religion or superstition. Sometimes over-protective moms can be just as irrational. Fragile Lives, for example, took us to Dublin, Ireland, where there have been two serious outbreaks of measles – largely due to mothers rejecting vaccination because of the MMR controversy. In some parts of Ireland only 60% instead of the necessary 95%, have been vaccinated.