Polio PDF
Polio PDF
Polio PDF
4019R362-9
Human Development & SDGs (E)
Prof. KATSUMA Yasushi
Introduction
Poliomyelitis (polio) is an infectious disease caused by the poliovirus that spreads through
orofecal transmission. It affects children ages 0-5 years old, invades their nervous system and causes
mild to deadly paralysis (CDC, n.d.; WHO, n.d.). Its global prevalence during the early 20th century led
to a consensus of developing IPV (inactivated poliovirus vaccines) and OPV (oral poliovirus vaccines)
(Paul, 1971, cited in Trevelyan, et al., 2004). Major stakeholders, such as WHO, national and local
government units (LGUs) alongside partnerships with NGOs implemented various responses to the
disease. In 1974, WHO established Expanded Program on Immunization (EPI) to immunize every child
from six vaccine-preventable diseases, including polio. EPI was also adopted by countries to implement
routine immunization programs nationwide. The following decade witnessed the launching of Global
Polio Eradication Initiative (GPEI), deemed as ‘the largest public health initiative in history’ by WHO
(Koenig-Archibugi, 2011), with the sole objective to eradicate wild poliovirus (WPV) by 2000, but the
goal was not achieved in the given time. Nevertheless, GPEI continues developing Polio Endgame
Strategy was established with four key strategies: surveillance; routine immunization; supplementary
immunization; and targeted mop-up campaigns (GPEI, n.d.).
Despite large-scale efforts, however, ensuring a world free of polio remains a challenge in the
global public health. This challenge is almost exclusive to developing countries in which WPV
continues to circulate. Low vaccination coverage, vaccine failure, poor hygiene and sanitation are
among the reasons why WPV transmission continues (Wassilak & Oresntein, 2014; WHO, 2017).
Consequently, a recent challenge emerged: the rise of vaccine-derived poliovirus (VDPV). The
mutation occurred when the weakened virus is excreted in an environment with inadequate sanitation
and poor hygiene, thereby facilitating its spread to nearby communities (WHO, 2017). Initially, public
health interventions were upon the responsibility of state actors, but the rise of contemporary non-state
actors were found to emerge through time (Held, 2015). These non-state actors include philanthropists,
private sector and NGOs that remain partners with state actors in a combined effort to eradicate polio.
This research paper aims to analyze the responses and challenges of state and non-state actors to the
polio outbreak in the Philippines.
The Philippines was declared polio-free in 2000 as the last known WPV case was found in 1993.
However, in September 2019, a VDPV case was found in a 3-year-old girl in the Mindanao region,
leading to the declaration of the comeback of polio outbreak after 19 years (WHO, 2019). Interestingly,
these viruses were already detected positive from sewage samples in Manila and Davao regions (DOH,
2019)—a month before the reemergence of the outbreak. The country is also recovering from the
nationwide vaccine scare due to the controversial dengue vaccine called Dengvaxia in 2017 that derailed
the public and gained huge mistrust in vaccines in general (Lasco & Larson et al., 2019; Larson et al.,
2019). Despite these issues, responses are ongoing through domestic immunization efforts from the
Department of Health (DOH), and partnerships with international and local organizations. The
Philippines’ case is worth analyzing to look into how the government responds to the polio outbreak,
including the role of non-state actors in the course of eliminating polio in the country despite the
mentioned pressing health issues. The role of non-state actors, most especially NGOs is understudied
in the subject matter of polio eradication in the Philippines. In line with achieving Sustainable
Development Goals (SDGs) Goals 3 (good health and well-being) and 6 (clean water and sanitation),
this study aims to assess how state actors mainstream polio awareness and prevention in the country,
and the gaps and challenges that need to be addressed. The study also emphasizes the engagement of
non-state actors, particularly community mobilization programs of NGOs in playing a vital role in the
course of eliminating the disease.
Body
The Philippines has long been detected high-risk for poliovirus transmission (DOH, 2019) and
recognized as under-immunized due to the steady decline of compliance to the 95% minimum vaccine
coverage as mandated by WHO (DOH, n.d.; UNICEF 2019, cited in Thorton, 2019) (fig. 1). Upon the
Dengvaxia controversy, which led to the vaccine hesitancy among Filipinos in 2017, the vaccination
confidence spiraled down from 93% in 2015 to 32% in 2018 (Larson, et al., 2019). Towards the
reemergence of polio outbreak in 2019, DOH responded through implementing polio immunization
campaigns. However, due to understaffing of personnel and resources to reach every village, the
national government and LGUs seek support with non-state actors such as WHO, UNICEF, and Rotary
International. This discussion evaluates current responses of actors to polio outbreak in the Philippines.
Conclusion
Emphasis on immunization drives, along with surveillance programs and other forms of
creative campaigning such as the use of mass media and rewarding of goods are among the major
responses of state actors to the polio outbreak in the Philippines. However, overlooking cultural factors
of communities, along with lack of strengthening in BHWs policies and neglecting underlying issues
like vaccine hesitancy are among the gaps and challenges in which can add constraints in ensuring polio
eradication in the country. While the health system intervention is LGU-based, community participation
must be engaged through empowering BHWs and non-state community volunteers in order to deliver
key messages to the people who need information about polio. The state actors place a steppingstone
of heightening awareness to polio nationwide, while the non-state actors with community-led responses
play a vital role in improving vaccination coverage, as well as in bringing important messages and
campaigning to the people in the community.
Limitations
This study only focused on the Philippine government’s responses to the reemerged polio
outbreak starting in 2019, with a limited overview and literature review of the current policies involved.
This is also the same with non-state actors’ response, with only focusing on one case study on the
contributions of the NGO Rotary. A more descriptive analysis on community participation cases in the
Philippines is recommended for possible further studies.
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