"Either you do or you don't," says Aylward. "If we stop now, in five years we don't go back to 1,000 cases a year. We're back to 1,000 cases per day. The only reason we can eradicate polio is that people in the industrial world lived through the terror of polio summers. In 10 years, there will be a new leadership who didn't know polio. It didn't touch their family."
With them goes that precious political and social will. This is something that Okwo-Bele sees as intolerable. "So many public health things have failed," he says. "In 1994, there were 32 countries in Africa with polio. At last count there were two. In Africa, to have tangible results is not common and so important. If we don't finish, it will be a big loss that could jeopardize everything else."
For The Record
Los Angeles Times Friday February 07, 2003 Home Edition Main News Part A Page 2 National Desk 10 inches; 365 words Type of Material: Correction
Rotary International theme -- An article in the Los Angeles Times Magazine on Rotary International's efforts to eradicate polio ("Superheroes in Bad Ties," Jan. 19) incorrectly stated this year's Rotary theme as "Sewing the seeds of love." It is "Sow the seeds of love."
For The Record
Los Angeles Times Sunday February 23, 2003 Home Edition Los Angeles Times Magazine Part I Page 10 National Desk 0 inches; 34 words Type of Material: Correction
The article on Rotary International's efforts to eradicate polio ("Superheroes in Bad Ties," Jan. 19) incorrectly stated this year's Rotary theme. It is "Sow the seeds of love."
Aylward agrees: "If we couldn't do this with the oral polio vaccine, what can we do?"
There is always the spark of recidivism to keep the dream alive. In 2002, the number of polio cases worldwide jumped to 1,351, with epidemics in Nigeria and India threatening Rotary's dream of global eradication by 2005. In Nigeria the political commitment is strong, but neighboring countries with low vaccine coverage offer an escape route for the virus. In India resources are strained because it has been combating the disease on a massive scale for years. Egypt has suffered a breakdown in monitoring. "This is when you need great leaders within and outside the health system to turn around some very tired people," says Aylward.
On the positive side, epidemics don't just devastate--they also inoculate. Although the number of cases in India is up, the outbreaks are localized in the state of Uttar Pradesh and are all caused by the same virus strain. If this winter's national immunization days go well, India may be polio-free by the end of 2003. The Type 2 poliovirus, one of three known types, has not been seen since 1999, and only 10 countries remain polio endemic, the lowest number ever. Pakistan has had a 20% drop in cases. Afghanistan--despite American bombings and restricted access to Kandahar and Tora Bora--is expected to stop transmission by the middle of this year. So are Angola, Niger and Somalia, despite vicious civil conflicts that can be extremely dangerous for vaccinators.
It doesn't matter, says Aylward. "We'll get them the vaccine. They can administer it themselves. If we can eradicate polio in [the Democratic Republic of the] Congo, it shows we can do it in regions in conflict. If we can do it in Bangladesh, it shows we can do it in the poorest countries. The strategies work."
"This is the biggest thing in public health ever," says Cochi. It's not just big in terms of the scope, but also in terms of its legacy. In the last 17 years, a worldwide network of 148 laboratories has been accredited to do the genetic sequencing of the poliovirus because it was impossible to eradicate without them. "We can build on the polio effort to do measles, yellow fever, bacterial meningitis and other infectious disease work," says Cochi.
The "plus" part of the "PolioPlus" campaign also is working. Vitamin A is administered along with the oral polio vaccine to decrease the susceptibility to measles and HIV. Cochi says that could reduce infant and child mortality rates by as much as 25%. The Styrofoam boxes have been segmented into different temperature zones to carry measles, tetanus and other vaccines for routine immunizations. Vaccine vial monitors, invented to identify whether the heat-sensitive oral polio vaccine has been exposed to high temperatures, have been added to the measles vaccine packaging.
"From now on all public-private partnerships will measure themselves against Rotary International in polio," says Aylward. "WHO, UNICEF, CDC, none could have done what Rotary has been able to do in terms of consistency of vision and leadership. They're different animals. Rotary doesn't answer to anyone except its own membership. They couldn't have done it without us. We couldn't have done it without them."
"This is visionary leadership for a community-based organization," says Patty Stonesifer, co-chair and president of the Bill & Melinda Gates Foundation, which awarded Rotary the $1-million Gates Award for Global Health in May 2002. "I was born in 1956. I never had a peer threatened by polio. Here we are 50 years later. I'm visiting India [and] watching a boy dragging himself around. There are low-cost vaccines and we didn't get them there. If after 20 years of searching for an HIV vaccine, we took another 50 years to roll it out, the cost to humanity would be unthinkable."
In the meantime, Rotary has gone back to its membership to raise another $80 million of a projected $275-million shortfall. This new campaign will allow the current membership--most were not around for the first campaign--to participate financially in what will be Rotary's greatest achievement.
Cyrus Johnson, now 79, is ready to answer the call. You'll find him at the door of a hotel ballroom in Westlake Village, greeting his Rotary club as they handshake their way into the room for their Wednesday lunch. He'll have on his Rotary tie and his ruby- and diamond-studded Rotary pins. His blue eyes will sparkle as he hugs the women, and he'll dance an excited jig when one of the men teases him about calling at 7 on a Sunday morning to see if he'd decided what he plans to do to rid the world of polio.