The last days of polio.

67Bulletin of the World Health Organization | January 2004, 82 (1) Photo Special 1 The End of Polio: A Global Effort to End a Disease was published in English by Bulfinch Press (AOL Time Warner Book Group) and produced by PixelPress, New York. The last days of polio In 2002, world-renowned Brazilian photographer, Sebastião Salgado, joined the global effort to eradicate polio. These photo- graphs, which are also published in his latest book, The End of Polio: A Global Effort to End a Disease,1 provide a visual account of the final stages of the fifteen-year campaign which aims to stop transmission by 2004. “As Sebastião Salgado’s luminous photographs attest, there are few more heartbreaking illustrations of the world’s negligence towards children than polio,” writes United Nations Secretary- General, Kofi Annan, in his foreword to the book which was launched in September 2003. Salgado’s photographs depict the tragic toll taken by this preventable disease and moments in the campaign against it. “The scale of it caught my attention,” says Salgado. “Though I had frequently visited most of the countries where polio is still a problem, I had not noticed what a terrible impact this disease still has. I was also not aware of the gigantic effort being made to eradicate it: millions of people delivering drops of polio vaccine to tens of millions of children. It is an amazing story that I wanted to help tell.” In 1988, when the World Health Assembly resolved to eradicate polio and the Global Polio Eradication Initiative was launched, there were more than125 polio-endemic countries. Now that figure has dropped to just six: Nigeria, India, Pakistan, Niger, Afghanistan, and Egypt. Somalia, after being polio-free year for one year, was taken off the list at the end of December 2003. Since the inception of the Global Polio Eradication Initia- tive — a global partnership spearheaded by WHO, Rotary International, US Centers for Disease Control and Prevention (CDC) and the United Nations Children’s Fund (UNICEF) — the number of polio cases has fallen from more than 350 000 in 1988 to 667 reported cases (as of 6 January 2004). However, ongoing transmission in the remaining polio- endemic countries threatens the 2004 target. As long as trans- mission continues in these countries, there is a risk that wild poliovirus could cross borders and become re-established in coun- tries and areas which have previously been polio-free. In West Africa, for example, an outbreak in northern Nigeria infected the neighbouring polio-free countries of Burkina Faso, Chad, Ghana and Togo in 2003. Responding to importations cost over US$ 20 million in emergency mop-up campaigns. Whilst significant progress has been made since 1988, stopping transmission by the end of 2004 is crucial if the disease is to be eradicated. “The immense efforts to eradicate polio have renewed my hope, my faith in solutions. The world cannot afford to miss this chance to finish with a disease,” says Salgado. O INDIA, 2001. The Amar Jyoti Rehabilitation and Research Center in New Delhi accommodates 540 children. In 2002, more than 80% of all new polio cases worldwide occurred in India. Ph ot og ra ph b y S eb as tiã o Sa lg ad o/ Am az on as Im ag es Sarah Jane Marshall, Bulletin 68 Bulletin of the World Health Organization | January 2004, 82 (1) Special Theme – Polio Eradication: End-Stage Challenges Photo Special SOMALIA, 2001. Mohamed Aden Ali, 11, paralyzed by polio, crawls on his hands and knees in the Baidoa stadium, where spectators have come to watch a football match between the teams Polio 2000 and Polio 2001. The match is one of a variety of activities used by immunizers to gain support for the eradication campaign in Baidoa, which was stricken by famine in the 1990s. SOMALIA, 2001. In 2001, several polio workers were held captive after a battle between their guards and militia from another clan. Because of continuing conflict, armed guards like these, in the village of Aboorrow, accompany foreigners who participate in polio eradication campaigns. Ph ot og ra ph b y S eb as tiã o Sa lg ad o/ Am az on as Im ag es Ph ot og ra ph b y S eb as tiã o Sa lg ad o/ Am az on as Im ag es 69Bulletin of the World Health Organization | January 2004, 82 (1) Special Theme – Polio Eradication: End-Stage Challenges Photo Special INDIA, 2001. During national immunization days in the town of Moradabad in Uttar Pradesh, trains cannot leave the railway station until all children on board have been vaccinated. In 2002, Uttar Pradesh experienced an outbreak of more than 1000 new polio cases — 66% of all the new cases in the world that year. PAKISTAN, 2001. The polio vaccine is administered in the village of Irro-Jo Whandhio in Mithi District, in the Thar Desert near the border with India's Rajasthan State. Ph ot og ra ph b y S eb as tiã o Sa lg ad o/ Am az on as Im ag es Ph ot og ra ph b y S eb as tiã o Sa lg ad o/ Am az on as Im ag es 70 Bulletin of the World Health Organization | January 2004, 82 (1) Special Theme – Polio Eradication: End-Stage Challenges Photo Special INDIA, 2001. During a round of national immunization days in Ghaziabad, Uttar Pradesh, a volunteer paints a girl's fingernail with gentian violet to indicate that she has received her polio vaccination. Several districts here and in the neighbouring state of Bihar are called polio "hot zones" because of continuing high-intensity transmission of the virus. PAKISTAN, 2001. Near Peshawar, children of displaced Punjabis are vaccinated. Ph ot og ra ph b y S eb as tiã o Sa lg ad o/ Am az on as Im ag es Ph ot og ra ph b y S eb as tiã o Sa lg ad o/ Am az on as Im ag es