WEBVTT 00:00:00.000 --> 00:00:02.928 align:middle line:90% [MUSIC PLAYING] 00:00:02.928 --> 00:00:08.035 align:middle line:90% 00:00:08.035 --> 00:00:10.410 align:middle line:84% OLAKUNLE ALONGE: So we're going to talk a little bit more 00:00:10.410 --> 00:00:12.880 align:middle line:84% about eradication of this strategy. 00:00:12.880 --> 00:00:15.730 align:middle line:84% So again we've talked about the vaccine. 00:00:15.730 --> 00:00:18.795 align:middle line:84% We've talked about the polio virus in and of itself. 00:00:18.795 --> 00:00:20.670 align:middle line:84% We talked about by the clinical manifestation 00:00:20.670 --> 00:00:21.780 align:middle line:90% of the polio virus. 00:00:21.780 --> 00:00:25.900 align:middle line:84% We've talked about the history of the polio and polio disease. 00:00:25.900 --> 00:00:29.270 align:middle line:84% And we've also talked about the two vaccines and the two 00:00:29.270 --> 00:00:32.070 align:middle line:84% different types of vaccines and the relative advantages 00:00:32.070 --> 00:00:36.450 align:middle line:84% and disadvantages of these two different types of polio 00:00:36.450 --> 00:00:37.710 align:middle line:90% vaccines. 00:00:37.710 --> 00:00:40.260 align:middle line:84% And indeed because we have the vaccine, 00:00:40.260 --> 00:00:42.720 align:middle line:84% because we have resources and the ability 00:00:42.720 --> 00:00:48.210 align:middle line:84% to surveil and to detect cases, eradication in of itself 00:00:48.210 --> 00:00:49.470 align:middle line:90% is the strategy. 00:00:49.470 --> 00:00:52.080 align:middle line:84% It's a [INAUDIBLE] strategy though that is made possible 00:00:52.080 --> 00:00:57.430 align:middle line:84% because of the availability of vaccines for polio. 00:00:57.430 --> 00:01:01.470 align:middle line:84% So we go back to the discussion around a debate between control 00:01:01.470 --> 00:01:04.801 align:middle line:90% versus eradication. 00:01:04.801 --> 00:01:08.560 align:middle line:84% So let's think about polio as an eradication strategy. 00:01:08.560 --> 00:01:10.940 align:middle line:84% Again the goal to eradicate polio. 00:01:10.940 --> 00:01:12.730 align:middle line:90% So why eradication. 00:01:12.730 --> 00:01:14.510 align:middle line:90% Why not other types of goals? 00:01:14.510 --> 00:01:15.680 align:middle line:90% Why not elimination? 00:01:15.680 --> 00:01:18.020 align:middle line:90% Why not control? 00:01:18.020 --> 00:01:20.440 align:middle line:84% There are different challenges or different goals 00:01:20.440 --> 00:01:24.120 align:middle line:84% that you can aim to achieve for addressing 00:01:24.120 --> 00:01:26.210 align:middle line:84% an infectious disease like polio. 00:01:26.210 --> 00:01:27.540 align:middle line:90% So one is control. 00:01:27.540 --> 00:01:29.470 align:middle line:84% Control would be the scenario where 00:01:29.470 --> 00:01:32.390 align:middle line:84% you bring down the disease to an acceptable level. 00:01:32.390 --> 00:01:34.060 align:middle line:84% So that is to say, yes the disease 00:01:34.060 --> 00:01:36.650 align:middle line:84% is still common within the population. 00:01:36.650 --> 00:01:40.630 align:middle line:84% But you're able to reduce the morbidity and mortality 00:01:40.630 --> 00:01:44.240 align:middle line:84% due to the disease to an acceptable level. 00:01:44.240 --> 00:01:46.870 align:middle line:84% So for this you require ongoing prevention measures 00:01:46.870 --> 00:01:51.470 align:middle line:84% and treatment measures to curtail the disease. 00:01:51.470 --> 00:01:53.970 align:middle line:84% And this is different from eradication which is really 00:01:53.970 --> 00:01:58.410 align:middle line:84% the goal to completely eliminate the disease-causing agent 00:01:58.410 --> 00:02:00.840 align:middle line:90% from the face of the world. 00:02:00.840 --> 00:02:04.770 align:middle line:84% So you really want to eliminate the incidence of the disease 00:02:04.770 --> 00:02:05.610 align:middle line:90% to zero. 00:02:05.610 --> 00:02:08.669 align:middle line:84% But that is to say that no individual, no one on Earth 00:02:08.669 --> 00:02:10.669 align:middle line:90% will be able to get the disease. 00:02:10.669 --> 00:02:12.480 align:middle line:84% And if you are able to achieve this, 00:02:12.480 --> 00:02:14.190 align:middle line:84% you can actually stop the prevention 00:02:14.190 --> 00:02:15.990 align:middle line:90% measures or for control. 00:02:15.990 --> 00:02:17.550 align:middle line:90% You can't stop vaccination. 00:02:17.550 --> 00:02:19.410 align:middle line:90% You can stop treatment. 00:02:19.410 --> 00:02:20.170 align:middle line:90% And so on. 00:02:20.170 --> 00:02:23.620 align:middle line:84% So all prevention measures can permanently end. 00:02:23.620 --> 00:02:26.550 align:middle line:84% An elimination is very similar to eradication. 00:02:26.550 --> 00:02:29.550 align:middle line:84% The only difference is just that you achieve the same 00:02:29.550 --> 00:02:33.870 align:middle line:84% as you achieve for eradication but within a limited 00:02:33.870 --> 00:02:35.310 align:middle line:90% geographical boundary. 00:02:35.310 --> 00:02:39.270 align:middle line:84% So either within a country or within a region. 00:02:39.270 --> 00:02:41.460 align:middle line:90% So why eradication for polio? 00:02:41.460 --> 00:02:43.200 align:middle line:90% Why not control? 00:02:43.200 --> 00:02:45.220 align:middle line:90% Why not elimination? 00:02:45.220 --> 00:02:47.580 align:middle line:84% And the answer to that is we go back 00:02:47.580 --> 00:02:50.790 align:middle line:84% to some of the criteria for or indicators 00:02:50.790 --> 00:02:52.890 align:middle line:90% for eradicating a disease. 00:02:52.890 --> 00:02:55.335 align:middle line:84% So one of the things about eradicating a disease 00:02:55.335 --> 00:02:57.510 align:middle line:84% is that you really want to be sure 00:02:57.510 --> 00:02:59.650 align:middle line:90% that eradication is possible. 00:02:59.650 --> 00:03:01.380 align:middle line:84% And eradication is possible based 00:03:01.380 --> 00:03:03.660 align:middle line:84% upon the biological concentration 00:03:03.660 --> 00:03:05.430 align:middle line:84% of the disease including the fact 00:03:05.430 --> 00:03:08.570 align:middle line:84% that humans should be the only [INAUDIBLE] for the disease. 00:03:08.570 --> 00:03:12.180 align:middle line:84% So that once you eliminate the disease among human population, 00:03:12.180 --> 00:03:14.640 align:middle line:84% then you would have achieved eradication. 00:03:14.640 --> 00:03:16.350 align:middle line:84% And there's no chance of amplification 00:03:16.350 --> 00:03:19.600 align:middle line:84% of the disease-causing agent within the environment. 00:03:19.600 --> 00:03:24.240 align:middle line:84% So earlier on, I was stunned that polio existed 00:03:24.240 --> 00:03:25.950 align:middle line:84% among only humans and it was also 00:03:25.950 --> 00:03:29.910 align:middle line:84% taught that the polio virus can only amplify within humans. 00:03:29.910 --> 00:03:32.780 align:middle line:84% And therefore eradication was set as the strategy. 00:03:32.780 --> 00:03:35.070 align:middle line:84% Even though as time went on, we begin 00:03:35.070 --> 00:03:38.790 align:middle line:84% to understand the biology of the virus even more. 00:03:38.790 --> 00:03:41.450 align:middle line:84% And there are reasons to believe that the virus can, 00:03:41.450 --> 00:03:45.180 align:middle line:84% in some regard, amplify within the environment. 00:03:45.180 --> 00:03:49.650 align:middle line:84% Either in the human host or just in close proximity 00:03:49.650 --> 00:03:50.550 align:middle line:90% to the human host. 00:03:50.550 --> 00:03:52.830 align:middle line:84% And this actually prevents challenge 00:03:52.830 --> 00:03:54.390 align:middle line:90% to the eradication goal. 00:03:54.390 --> 00:03:56.250 align:middle line:84% And then again, the other notion is 00:03:56.250 --> 00:03:59.340 align:middle line:84% that you should have political commitments 00:03:59.340 --> 00:04:02.040 align:middle line:84% across different countries, across different regions, 00:04:02.040 --> 00:04:06.180 align:middle line:84% at different levels in order to achieve eradication. 00:04:06.180 --> 00:04:10.380 align:middle line:84% And all of this took place as far back as in 1988, 00:04:10.380 --> 00:04:14.750 align:middle line:84% when the Global Polio Eradication Initiative was set. 00:04:14.750 --> 00:04:17.760 align:middle line:84% Over the years, there's been some dynamic changes 00:04:17.760 --> 00:04:20.160 align:middle line:84% in our understanding of the biology of the disease. 00:04:20.160 --> 00:04:23.080 align:middle line:84% There's been a lot of changes to the commitments 00:04:23.080 --> 00:04:27.000 align:middle line:84% on the political level in terms of leadership at country level, 00:04:27.000 --> 00:04:30.270 align:middle line:84% at national level, at regional level. 00:04:30.270 --> 00:04:30.770 align:middle line:90% And so on. 00:04:30.770 --> 00:04:34.620 align:middle line:84% That has really questioned the eradication goal 00:04:34.620 --> 00:04:37.180 align:middle line:90% for the polio program. 00:04:37.180 --> 00:04:40.650 align:middle line:84% But again the program is close to achieving 00:04:40.650 --> 00:04:44.160 align:middle line:84% eradication given that over 99% of the cases 00:04:44.160 --> 00:04:48.060 align:middle line:84% have declined for polio over the course of the 30 years 00:04:48.060 --> 00:04:52.520 align:middle line:84% at the Global Polio Eradication Initiative has been in place. 00:04:52.520 --> 00:04:55.530 align:middle line:84% Eradication is really difficult, as you can imagine. 00:04:55.530 --> 00:04:58.570 align:middle line:84% I mean, it's not just for you to have a vaccine. 00:04:58.570 --> 00:05:01.640 align:middle line:84% It's not just for you to have an effective vaccine. 00:05:01.640 --> 00:05:03.710 align:middle line:90% The vaccine has to be delivered. 00:05:03.710 --> 00:05:05.690 align:middle line:84% So there's a lot of implementation 00:05:05.690 --> 00:05:09.620 align:middle line:84% and consideration that has to be true in terms 00:05:09.620 --> 00:05:10.803 align:middle line:90% of delivering the vaccine. 00:05:10.803 --> 00:05:12.470 align:middle line:84% And then the vaccine has to be delivered 00:05:12.470 --> 00:05:18.150 align:middle line:84% all children all eligible population across the world. 00:05:18.150 --> 00:05:21.270 align:middle line:84% So you have to do that across different geographies, 00:05:21.270 --> 00:05:22.520 align:middle line:90% different boundaries. 00:05:22.520 --> 00:05:24.350 align:middle line:84% And then you have scenarios where 00:05:24.350 --> 00:05:26.040 align:middle line:84% there's different governor structures 00:05:26.040 --> 00:05:28.940 align:middle line:84% and political structures in different countries. 00:05:28.940 --> 00:05:31.490 align:middle line:84% So you have to work within those political contexts. 00:05:31.490 --> 00:05:33.350 align:middle line:84% There are different cultural beliefs, 00:05:33.350 --> 00:05:35.180 align:middle line:90% different societal norms. 00:05:35.180 --> 00:05:37.250 align:middle line:84% You have to work within the societal norms. 00:05:37.250 --> 00:05:40.340 align:middle line:84% You have to overcome the areas of a plain view that 00:05:40.340 --> 00:05:41.373 align:middle line:90% are post by that. 00:05:41.373 --> 00:05:43.040 align:middle line:84% And then there are different individuals 00:05:43.040 --> 00:05:47.050 align:middle line:84% that are involved from the parents, the caregivers, 00:05:47.050 --> 00:05:49.810 align:middle line:84% to the health workers to the administrator at district 00:05:49.810 --> 00:05:53.810 align:middle line:84% and regional and national level, to actors at global level, 00:05:53.810 --> 00:05:54.630 align:middle line:90% and so on. 00:05:54.630 --> 00:05:58.500 align:middle line:84% So you have all of these working together as a complex system. 00:05:58.500 --> 00:06:02.510 align:middle line:84% So the eradication programs are difficult because it 00:06:02.510 --> 00:06:06.080 align:middle line:84% requires implementation within a very complex system. 00:06:06.080 --> 00:06:09.800 align:middle line:84% And therefore, there have been very few examples 00:06:09.800 --> 00:06:13.040 align:middle line:84% of a successful eradication program. 00:06:13.040 --> 00:06:16.220 align:middle line:84% So we know that there have been at least 00:06:16.220 --> 00:06:20.720 align:middle line:84% seven different programs that have been candidate 00:06:20.720 --> 00:06:23.180 align:middle line:84% for eradication or diseases that I've been candidates 00:06:23.180 --> 00:06:24.460 align:middle line:90% for eradication. 00:06:24.460 --> 00:06:26.110 align:middle line:84% And only one of them has succeeded 00:06:26.110 --> 00:06:28.700 align:middle line:84% and that's the smallpox eradication. 00:06:28.700 --> 00:06:31.460 align:middle line:84% And the smallpox eradication is unique in and of itself 00:06:31.460 --> 00:06:35.220 align:middle line:84% because of the nature of the virus that causes smallpox. 00:06:35.220 --> 00:06:36.630 align:middle line:90% It's a DNA virus. 00:06:36.630 --> 00:06:38.980 align:middle line:84% It's more stable than having a virus that 00:06:38.980 --> 00:06:40.610 align:middle line:90% is polio before his start. 00:06:40.610 --> 00:06:42.500 align:middle line:84% And there are clinical manifestation 00:06:42.500 --> 00:06:47.410 align:middle line:84% for smallpox in almost all of the cases that get smallpox. 00:06:47.410 --> 00:06:48.710 align:middle line:90% You are able to identify cases. 00:06:48.710 --> 00:06:50.380 align:middle line:84% You are able to quarantine cases that 00:06:50.380 --> 00:06:52.010 align:middle line:84% really set in preventive measures 00:06:52.010 --> 00:06:54.225 align:middle line:90% in addition to the vaccine. 00:06:54.225 --> 00:06:55.600 align:middle line:84% For some of these other diseases, 00:06:55.600 --> 00:06:57.860 align:middle line:84% they don't have some of these clinical purposes. 00:06:57.860 --> 00:07:01.430 align:middle line:84% So for polio for instance, we see that in majority of cases 00:07:01.430 --> 00:07:03.260 align:middle line:90% you don't see the infection. 00:07:03.260 --> 00:07:05.660 align:middle line:84% So therefore it becomes difficult for you 00:07:05.660 --> 00:07:08.630 align:middle line:84% to identify cases to isolate cases and so on. 00:07:08.630 --> 00:07:10.440 align:middle line:84% And therefore some of these other diseases 00:07:10.440 --> 00:07:12.290 align:middle line:84% either have other issues and challenges. 00:07:12.290 --> 00:07:14.670 align:middle line:90% The eradication goal is good. 00:07:14.670 --> 00:07:18.030 align:middle line:84% Eradicating diseases or setting up an eradication program 00:07:18.030 --> 00:07:23.300 align:middle line:84% are indeed very difficult. And the polio program provides us 00:07:23.300 --> 00:07:28.370 align:middle line:84% with very useful lessons for our future eradication activities 00:07:28.370 --> 00:07:32.540 align:middle line:84% and also for the global health programs. 00:07:32.540 --> 00:07:34.160 align:middle line:84% Like I mentioned earlier on polio 00:07:34.160 --> 00:07:37.060 align:middle line:84% is harder than the smallpox to eradicate 00:07:37.060 --> 00:07:40.280 align:middle line:84% for some of the reasons that I described. 00:07:40.280 --> 00:07:43.590 align:middle line:90% One the biology of the virus. 00:07:43.590 --> 00:07:46.190 align:middle line:90% So smallpox virus is DNA. 00:07:46.190 --> 00:07:49.370 align:middle line:84% And DNA viruses must die around the viruses. 00:07:49.370 --> 00:07:52.580 align:middle line:84% So the extent to which they change genetic material 00:07:52.580 --> 00:07:53.480 align:middle line:90% is less frequent. 00:07:53.480 --> 00:07:57.370 align:middle line:84% And therefore vaccines are able to confer protection 00:07:57.370 --> 00:07:59.917 align:middle line:84% in the mist of regaining virulence 00:07:59.917 --> 00:08:01.250 align:middle line:90% as we have with the polio virus. 00:08:01.250 --> 00:08:03.577 align:middle line:84% It's really unlikely for the smallpox. 00:08:03.577 --> 00:08:05.660 align:middle line:84% And the second thing is the clinical manifestation 00:08:05.660 --> 00:08:06.380 align:middle line:90% of smallpox. 00:08:06.380 --> 00:08:07.220 align:middle line:90% It's classical. 00:08:07.220 --> 00:08:11.040 align:middle line:84% And you see lashes, patients that are healed. 00:08:11.040 --> 00:08:14.730 align:middle line:84% And this allows you to wrap to readily identify cases, 00:08:14.730 --> 00:08:16.950 align:middle line:84% and to isolate cases, and to quarantine 00:08:16.950 --> 00:08:19.400 align:middle line:84% the cases and the close contact to the cases. 00:08:19.400 --> 00:08:23.000 align:middle line:84% And you can put in other measures outside of vaccination 00:08:23.000 --> 00:08:24.500 align:middle line:90% to control the disease. 00:08:24.500 --> 00:08:27.460 align:middle line:84% And this helped with the eradication of the smallpox. 00:08:27.460 --> 00:08:29.960 align:middle line:84% Unlike the polio, it's not every case 00:08:29.960 --> 00:08:31.890 align:middle line:90% that has polio that manifest. 00:08:31.890 --> 00:08:33.059 align:middle line:90% So you really don't know. 00:08:33.059 --> 00:08:34.809 align:middle line:84% And therefore it becomes difficult for you 00:08:34.809 --> 00:08:38.750 align:middle line:84% to isolate or quarantine and to do ring-fencing immunization 00:08:38.750 --> 00:08:41.330 align:middle line:90% as was done with smallpox. 00:08:41.330 --> 00:08:43.549 align:middle line:84% So again the biology of the virus 00:08:43.549 --> 00:08:46.370 align:middle line:84% itself, the chemical manifestation of the virus, 00:08:46.370 --> 00:08:49.010 align:middle line:84% and then also the eradication needs 00:08:49.010 --> 00:08:52.520 align:middle line:84% to happen within a timely fashion. 00:08:52.520 --> 00:08:55.130 align:middle line:84% You can imagine that when you are trying 00:08:55.130 --> 00:08:59.100 align:middle line:84% to achieve eradication and this becomes protracted 00:08:59.100 --> 00:09:02.210 align:middle line:84% because attention wins, commitment wins over time. 00:09:02.210 --> 00:09:03.318 align:middle line:90% Resources also wins. 00:09:03.318 --> 00:09:04.610 align:middle line:90% So it becomes more challenging. 00:09:04.610 --> 00:09:07.110 align:middle line:84% And that's one thing that has happened to the polio program. 00:09:07.110 --> 00:09:10.220 align:middle line:84% There's been a lot of challenges over the years, which 00:09:10.220 --> 00:09:12.980 align:middle line:84% has really impacted on the commitments 00:09:12.980 --> 00:09:15.350 align:middle line:84% both at a political level and the implementation 00:09:15.350 --> 00:09:18.615 align:middle line:84% level in specific countries to sustain the effort. 00:09:18.615 --> 00:09:19.990 align:middle line:84% There are other examples as well. 00:09:19.990 --> 00:09:22.070 align:middle line:84% But I really want you to take a pause 00:09:22.070 --> 00:09:24.050 align:middle line:84% and reflect on some of this in just 00:09:24.050 --> 00:09:27.590 align:middle line:84% comparing the polio and the smallpox eradication 00:09:27.590 --> 00:09:29.930 align:middle line:90% initiatives. 00:09:29.930 --> 00:09:33.530 align:middle line:84% again, just to emphasize that polio eradication is truly 00:09:33.530 --> 00:09:37.280 align:middle line:84% an enormous endeavor that requires coalition, 00:09:37.280 --> 00:09:41.460 align:middle line:84% collaboration at the global level. 00:09:41.460 --> 00:09:44.220 align:middle line:84% So you need to think about it in terms of the scope, the time, 00:09:44.220 --> 00:09:48.390 align:middle line:84% the resources which requires implementation of evidence 00:09:48.390 --> 00:09:52.030 align:middle line:84% supported intervention across different settings 00:09:52.030 --> 00:09:55.370 align:middle line:84% both social, political, economic settings. 00:09:55.370 --> 00:09:59.770 align:middle line:84% It requires activities and coordination at various levels, 00:09:59.770 --> 00:10:02.640 align:middle line:84% at the global level, at the regional level, 00:10:02.640 --> 00:10:05.150 align:middle line:84% at the national level, at the sub-national level. 00:10:05.150 --> 00:10:06.740 align:middle line:90% It requires many actors. 00:10:06.740 --> 00:10:11.250 align:middle line:84% So here you see in this picture a natural administering polio 00:10:11.250 --> 00:10:15.440 align:middle line:84% or a polio vaccine to a child in a train in India. 00:10:15.440 --> 00:10:18.470 align:middle line:84% And indeed you see there's a lot of people involved. 00:10:18.470 --> 00:10:21.020 align:middle line:84% So from the parents of the child to the health worker 00:10:21.020 --> 00:10:24.230 align:middle line:84% to the supervisors to the district officers 00:10:24.230 --> 00:10:27.590 align:middle line:84% to people who do surveillance to political leaders who makes 00:10:27.590 --> 00:10:29.710 align:middle line:90% policies at different levels. 00:10:29.710 --> 00:10:32.380 align:middle line:84% So there are different actors that are involved. 00:10:32.380 --> 00:10:34.030 align:middle line:84% And because of the the peculiarity 00:10:34.030 --> 00:10:37.430 align:middle line:84% of the different contexts, we also require different forms 00:10:37.430 --> 00:10:41.400 align:middle line:84% of strategies to facilitate and to overcome the areas 00:10:41.400 --> 00:10:43.040 align:middle line:90% across different contexts. 00:10:43.040 --> 00:10:47.540 align:middle line:84% So eradication as strategy, eradication as a goal, 00:10:47.540 --> 00:10:50.370 align:middle line:84% it's an undertaking that is not to be taken lightly. 00:10:50.370 --> 00:10:54.200 align:middle line:84% It's something that requires the best science, the best 00:10:54.200 --> 00:10:56.790 align:middle line:90% knowledge to try to implement. 00:10:56.790 --> 00:11:01.250 align:middle line:84% And also commitment over time across different levels. 00:11:01.250 --> 00:11:04.860 align:middle line:84% This slide is really for us to highlight how the global polio 00:11:04.860 --> 00:11:09.220 align:middle line:84% eradication campaign has intensified in recent times. 00:11:09.220 --> 00:11:16.500 align:middle line:84% So you would see that like the chain in 1988 and 2008, 00:11:16.500 --> 00:11:19.860 align:middle line:84% the Global Polio Eradication Initiative achieved 00:11:19.860 --> 00:11:23.250 align:middle line:84% a rapid decline in the number of cases of polio 00:11:23.250 --> 00:11:27.450 align:middle line:84% from about 350000 cases to about 1500 cases. 00:11:27.450 --> 00:11:32.760 align:middle line:84% And then between 2008 to 2018, it was a lot harder 00:11:32.760 --> 00:11:37.560 align:middle line:84% to reduce the cases because of a specific contextual issue 00:11:37.560 --> 00:11:39.340 align:middle line:90% within this population. 00:11:39.340 --> 00:11:44.340 align:middle line:84% So over that period activities for mass immunization kind of 00:11:44.340 --> 00:11:46.520 align:middle line:90% ramped up rapidly. 00:11:46.520 --> 00:11:49.650 align:middle line:84% And this slide and the map that you see really 00:11:49.650 --> 00:11:53.610 align:middle line:84% shows to you how campaigns, and needless to say activities 00:11:53.610 --> 00:11:58.770 align:middle line:84% by which we vaccine workers and health workers go from 00:11:58.770 --> 00:12:01.890 align:middle line:84% door to door, or go to a specific location 00:12:01.890 --> 00:12:05.580 align:middle line:84% to immunize and deliver the vaccine to children 00:12:05.580 --> 00:12:08.010 align:middle line:90% intensify over time. 00:12:08.010 --> 00:12:12.960 align:middle line:84% So you see the intensity shaded by the color. 00:12:12.960 --> 00:12:14.880 align:middle line:84% So looking at the African region, 00:12:14.880 --> 00:12:17.580 align:middle line:84% you will see that the darker shade of blue 00:12:17.580 --> 00:12:23.400 align:middle line:84% is really where you have between five to nine campaigns 00:12:23.400 --> 00:12:23.940 align:middle line:90% by child. 00:12:23.940 --> 00:12:27.680 align:middle line:84% This is to say that a child in that year 00:12:27.680 --> 00:12:32.500 align:middle line:84% received a vaccine from a campaign program that requires 00:12:32.500 --> 00:12:34.500 align:middle line:84% health workers to go door to door, 00:12:34.500 --> 00:12:37.590 align:middle line:84% house to house, or from location to location, 00:12:37.590 --> 00:12:39.870 align:middle line:84% between five to nine times within the year. 00:12:39.870 --> 00:12:43.020 align:middle line:84% So indeed it shows to you the skills 00:12:43.020 --> 00:12:45.480 align:middle line:84% of what it would entail to achieve that. 00:12:45.480 --> 00:12:50.400 align:middle line:84% I mean this occurred in places like Niger Republic in Africa. 00:12:50.400 --> 00:12:54.610 align:middle line:84% You see in West Africa one of the darkest shade in Chad. 00:12:54.610 --> 00:12:56.640 align:middle line:90% In West Africa, it's Sudan. 00:12:56.640 --> 00:12:58.700 align:middle line:90% In parts of North Africa. 00:12:58.700 --> 00:13:03.200 align:middle line:84% And then the next dark shade of blue 00:13:03.200 --> 00:13:06.390 align:middle line:84% really shows to you where the campaign occurred between three 00:13:06.390 --> 00:13:08.220 align:middle line:90% to five parents per child. 00:13:08.220 --> 00:13:11.490 align:middle line:84% And then the lighter shade we had about two 00:13:11.490 --> 00:13:16.330 align:middle line:84% to three or between one to two campaigns per child per year. 00:13:16.330 --> 00:13:19.060 align:middle line:84% So again it shows to you the intensity. 00:13:19.060 --> 00:13:22.290 align:middle line:84% So not only do you have two set in all of these actors, all 00:13:22.290 --> 00:13:25.980 align:middle line:84% of these mechanisms alive for a particular point in time. 00:13:25.980 --> 00:13:29.040 align:middle line:84% You have to do it repeatedly over time 00:13:29.040 --> 00:13:32.360 align:middle line:90% within the same population. 00:13:32.360 --> 00:13:36.050 align:middle line:84% And therefore, given the nature of the disease, 00:13:36.050 --> 00:13:38.860 align:middle line:84% it's really important that no child is left out. 00:13:38.860 --> 00:13:43.670 align:middle line:84% It's really important that every child that is susceptible, 00:13:43.670 --> 00:13:47.210 align:middle line:84% every eligible population receive the vaccine. 00:13:47.210 --> 00:13:49.600 align:middle line:84% So you have to achieve perfection, 00:13:49.600 --> 00:13:53.210 align:middle line:84% even given all of the challenges that 00:13:53.210 --> 00:13:56.540 align:middle line:84% are posed by the different contexts in which the program 00:13:56.540 --> 00:13:58.670 align:middle line:90% has to be implemented. 00:13:58.670 --> 00:14:00.305 align:middle line:84% Because just missing out one child, 00:14:00.305 --> 00:14:02.520 align:middle line:84% or missing out two children, or missing out 00:14:02.520 --> 00:14:06.540 align:middle line:84% a couple of villages, we will hum poppy the eradication goal. 00:14:06.540 --> 00:14:11.780 align:middle line:84% So, there's a zero allowance of missing 00:14:11.780 --> 00:14:13.520 align:middle line:90% any child or a population. 00:14:13.520 --> 00:14:17.880 align:middle line:84% So therefore, to achieve eradication as a goal 00:14:17.880 --> 00:14:21.000 align:middle line:84% in order to extinct diseases from the patient you have, 00:14:21.000 --> 00:14:22.330 align:middle line:90% perfection is essential. 00:14:22.330 --> 00:14:24.830 align:middle line:84% And then to think about achieving perfection 00:14:24.830 --> 00:14:28.460 align:middle line:84% across different contexts, across different boundaries, 00:14:28.460 --> 00:14:32.210 align:middle line:84% really allows you to see how difficult 00:14:32.210 --> 00:14:34.980 align:middle line:84% and how challenging the polio eradication initiative 00:14:34.980 --> 00:14:35.840 align:middle line:90% has been. 00:14:35.840 --> 00:14:38.460 align:middle line:84% Despite these challenges, there has been a lot of success. 00:14:38.460 --> 00:14:41.480 align:middle line:84% And we hear more about some of this successes some of us 00:14:41.480 --> 00:14:44.000 align:middle line:90% will go on and discuss it. 00:14:44.000 --> 00:14:47.350 align:middle line:90% [MUSIC PLAYING] 00:14:47.350 --> 00:14:51.000 align:middle line:90%