N othing steels the resolve of physician Robert S. “Bob” Scott more than polio, a disease long banished from industrialized nations but still paralyzing children in some corners of the world.

A member of the Rotary Club of Cobourg, Ont., Canada, since 1971, he’s a longtime active supporter of Rotary’s battle against polio. Scott became chair of the International PolioPlus Committee on 1 July 2006, replacing William T. Sergeant, who retired after 12 years in the office.

As the year in Rotary’s top PolioPlus position came to a close, Scott talked with Managing Editor Marla Donato about the new strategy to eliminate the disease in the remaining four endemic countries, recent positive news, and the critical need to fulfill Rotary’s promise of a polio-free world.

Do you believe eradication is possible?
Oh, absolutely. Otherwise, I wouldn’t be continuing to persuade Rotarians and the Rotary world to keep at it.

Where are we right now in terms of polio eradication?
To be frank, the progress in the last few years has been much slower than expected. However, the virus is now only endemic in very discrete, small areas of four countries – namely India, Pakistan, Afghanistan, and Nigeria. It is endemic in two northern states of India, Bihar and Uttar Pradesh; no more than six northern states of Nigeria; and in Afghanistan and Pakistan, the border between the two countries.

What are the challenges in each of these areas?
The challenges are different in each small area in each country. In January, PolioPlus adopted tailored approaches to reach the last children. This is the single biggest development since the program was launched in 1985. In northern Nigeria, for about a year, leaders stopped all polio vaccinations to children. It was undoubtedly a political, cultural, and partly a religious problem. That has now been resolved, and the cases are dropping rapidly. Along with the polio drops, they are also giving other vaccines – add-ons for diphtheria, measles – and malaria nets, and this has proven
very successful.

In India, it is the huge population we have to deal with. For example, in Uttar Pradesh, there are more than five million births a year. In northern India, children who are extremely malnourished have many different viruses and bacteria, and the polio drops don’t always produce the desired immunity because of these competing pathogens. So the rounds of Subnational Immunization Days are now every month. There has been some religious objection, but that has virtually melted away. I met twice with the mullahs [Islamic clergy] last year. Great follow-up by the Indian Rotarians has continued to result in very few mothers and fathers denying their children the vaccine.

And in the remaining two countries?
In Afghanistan and Pakistan, the problem is the fighting. Polio has a way of stopping fighting, because we have Days of Tranquility, where we negotiate with the warring factions so that we can vaccinate their children. Especially in places like the Democratic Republic of the Congo and Côte d’Ivoire, Rotarians were very much part of stopping the fighting. I can’t say I’m quite as hopeful about the Taliban in Afghanistan. They seem to have become very warlike again. At one time, the Taliban were very much on our side, and I’ve got some wonderful photographs of Taliban men helping with vaccinations.

So what happened there?
Well, politics got in the road. However, Hamid Karzai, the president of Afghanistan, formed and chairs the National Polio Action Group. President Karzai receives reports on a regular basis, which has resulted in only three cases in the first six months of this year.

Should people in countries where polio is no longer a threat still vaccinate their children?
Absolutely. Every time I give a talk in North America or in Europe, I say to the audience that they must ensure that their children and grandchildren are vaccinated against polio. Because look what happened: From Nigeria and India, there have been 64 exports of the virus to other countries over the last several years, resulting in serious outbreaks of polio. Eighty-two percent of the viruses came from Nigeria, and the rest came from India. The cost, to date, is US$475 million. The same could happen in the U.S. or Canada or Europe if routine immunization is not kept at a high level. It is essential to have your children vaccinated against all the preventable diseases, including polio.

Namibia last experienced an outbreak in 2006 that was unusual because it was among adults. Was that a big surprise?
Well, those of us who are old enough remember that the poliovirus used to affect adults as well. But it really is a disease of the younger age group – five years and under. And that’s why, in the old days, it was called infantile paralysis. We were scared, every July, August, that we were next in line. Swimming pools and cinemas were closed, and every fall there was always a rise in cases. Then, of course, there were the huge epidemics in the late ’40s, early ’50s.

How are we doing in funding for this final push?
The number-one problem in the eradication of polio is the lack of funds.

How much money have we spent?
To date, the global investment in polio eradication has been more than $5 billion through 2008. Rotary has provided nearly $620 million, and we expect to have provided more than $670 million by the time polio is certified as eradicated. At this moment, the PolioPlus Fund has about $54 million left for further grants to the World Health Organization and UNICEF.

And that will be enough?
No, not nearly enough. Our major problem is shortfalls, every year. [Editor’s note: The current shortfall is $540 million over the calendar years 2007 and 2008.] Along with WHO, UNICEF, and the United Nations Fund, we’ve been very successful. The $5 billion has mostly come from governments. The total from the United States at the moment is over $1.2 billion. Then Rotary is second, at $620 million, followed by the United Kingdom, Japan, and Canada.

What can Rotarians do? Are they experiencing donor fatigue?
As I travel the world and speak to many Rotary clubs and Rotary gatherings, I find great enthusiasm is still present. I just wonder how much of that enthusiasm carries over to the next day or to the next meeting. What I would like to see in the ideal Rotary world would be for every Rotary club, again, to have a polio committee. Many clubs have long gone without polio committees. I would also like every district to continue having a polio committee. There are districts that do not have polio committees anymore, and this is unfortunate. This Rotary year, I believe every Rotary club should have at least one meeting on PolioPlus, and every district should make a donation to PolioPlus Partners.

When did this trend of clubs and districts eliminating polio committees start becoming noticeable?
The last three or four years. There have been two campaigns that raised a huge amount of money: $247 million the first campaign, $135 million the second campaign. Every year, the PolioPlus Fund receives $1 million to $2 million, even though there is no official campaign, from generous Rotarians. Many incorrectly believe polio is eradicated, and therefore many clubs and districts no longer have active PolioPlus committees.

Is polio still a Foundation priority?
When Past RI President Bhichai Rattakul announced the Foundation’s goals for this Rotary year, he said that the number one would be communicating that polio eradication is realistic. Last year, Trustee Chair Luis Giay made polio the number-one emphasis. It should continue to be so, in my opinion, until eradication is certified.

What kinds of questions come to you from Rotarians in the field?
The number-one question is why don’t we get enough publicity? The number-two question is when do you think it’s going to finish? I don’t give a date anymore. Initially, the eradication effort was going very quickly. We started in 1985 with more than 125 countries, and by the year 2000, we were down to only 20 countries. Then the pace slowed, which was unexpected. Rotarians ask me many times, when do you think we will finish? I have no idea. We will finish when that last virus is eradicated. We have not failed. We have cleared out 99 percent of the virus from the world. Three WHO regions have been certified polio-free, and type 2 poliovirus has not been detected anywhere in the world for about nine years. It is likely eradicated. That is a success in itself. It is not the final goal, but it is very close to it. I’m convinced we can reach that final goal. I mean, I’ve been at it long enough to be absolutely convinced that we can do this, given enough funding.

And that question about publicity?
Rotary gets a tremendous amount of press worldwide, both in written and TV reports. I go to India, and there’s press all over the place. In the United States, Canada, and in Europe and the UK, we don’t get that same publicity, because polio isn’t around. People have forgotten about it. It isn’t the bad-news story the press often like to pick up. My answer to the Rotarians who ask that question is when did you last write to your newspaper about polio and Rotary? That’s the number-one thing all Rotarians can do: continually increase the advocacy in press, radio, television.

What do you think is the most important message for Rotarians?
In April, the representatives to the Council on Legislation from around the world voted by a huge majority of 93 percent to continue polio as the only corporate focus of Rotary International. Rotarians of the world still believe in the eradication of polio and have voted strongly in support. Now we must get mobilized, in all parts of the Rotary world, yet again, to finally eradicate this disease by making sure polio committees are active and support of PolioPlus Partners is present in every district. Generally encourage the public; get PolioPlus known again, especially among new Rotarians.

So what you really want is advocacy?
Advocacy to the governments and their ministers of finance, ministers of health. Of course, Rotary, through the Polio Eradication Advocacy Task Force, does lobby extensively. But if 1.2 million Rotarians phoned their government and said “This is terrible, it’s a disgrace that we haven’t eradicated polio,” I believe this could have tremendous impact.

So this is a vote of confidence, so you can go to the governments and say: “Look, we’re still unanimous. We’re in it for the long haul.”
Yes. There are many good stories, you know? Very few cases left, very few areas, in four countries. Dr. Margaret Chan, the new leader of WHO, is very, very supportive of the polio eradication initiative and of Rotary’s major role. She asked to meet with Rotary only eight days after she was elected. Immediate Past RI President Bill Boyd and I had a very fruitful meeting with her on 8 January. Another positive sign, from Africa, was evident when President Boyd received a letter from the new president of the African Union, who also happens to be president of Ghana, giving us enormous support. In that letter, he supports the polio program in every aspect, and he is willing not only to support it but to advocate it to other leaders, especially those in Africa and the G8 countries. We have had G8 support in the past, and we’re hoping that will continue. The results of the last meeting of this body were not encouraging. In truth, we must have their support to finish eradication.

Any other good news?
Two articles [in the Lancet journal and Science magazine], pointing out that over the long term, eradicating polio is much cheaper than controlling it. Secondly, we’ve got vaccines that are much more effective. Other research shows the new monovalent oral polio vaccine type 1 is three times as effective as the original trivalent vaccine. So there’s a great deal of positive news.

These researchers say it will cost three times as much to control polio than to eradicate it – is that correct?
It could be much more, depending on how you control it. I always say that we haven’t gotten it under control until we’ve eradicated it.

What would you tell the naysayers of the world?
I would say they are believing false or perhaps convenient science. We have shown it is possible to eradicate polio. Every country that has large numbers of children who are susceptible to polio due to poor immunization schedules and has had an import of polio from India or Nigeria has always, for a second time, eradicated polio. We know how to eradicate polio. So, if you want to have up to 250,000 children suffer from polio and a life of disability, carry on with a control policy. But if you do not want that to happen, no matter what the cost, eradicate polio.

What will happen if we go into control mode, in terms of both financial and human suffering?
Be prepared that some children will get polio, some children will die from polio, and most of the children who will die will be in the poor countries. Not in the United States, not in Canada, because there is good routine immunization. It is in the poorer countries where routine immunization is very poor because they are unable to afford it – they will have more cases of polio. So is it acceptable to have 40,000 cases a year? Four hundred thousand? What’s acceptable? Consider the cost overall, and the long-term cost of keeping these poor children in crutches, wheelchairs, surgery to correct contractions of muscles – an agonizing life. That’s what is being advocated. Morally, to me, this is totally unacceptable.

What are some concrete actions that Rotarians can take?
Continue to educate and inform themselves on all aspects of the polio eradication initiative. I am delighted to note that every Rotary institute this year is having a presentation on polio. Following these institutes, I ask the leadership to take the polio message home and give it to the clubs, to fellow Rotarians. Keep polio in front of Rotarians until they’re mad at you and, by inference, me. We gave a copy of the Case for Finishing Polio Eradication to every district governor-elect at the International Assembly in February. I had it re-sent to every district governor with a letter asking them to please circulate it. Get polio out there again – get it on the front burner of every club and district. I asked district governors to send the case statement out to all the clubs in their district. Well, I know it happened in my own district, because my own governor sent it to me!

What’s the power of PolioPlus Partners?
Yes, that’s another positive thing Rotarians and districts can do. Let me explain. Money donated to the PolioPlus Fund is funneled through to WHO or UNICEF in grants authorized by The Rotary Foundation Trustees. Money given to PolioPlus Partners is used by Rotarians. It is money applied for by Rotarians in the four polio-endemic and highest-risk countries that are having National Immunization Days or Subnational Immunization Days. The moneys are used for social mobilization, for the very well-known National Immunization Day uniform with its Rotary colors, and other essentials, such as the whistles or hats or crayons they give the children, or the megaphones or bicycles or motorcycles. That money is Rotarians giving money directly to Rotarians. Past RI President Chuck Keller and Trustee Lou Piconi are cochairs of the PolioPlus Partners Task Force. They’ve done a fantastic job of making the world knowledgeable about PolioPlus Partners and how to donate to it. At this time, on all donated cash or District Designated Fund contributions, there is a 50-cent match from the PolioPlus Fund.

In your travels around the world, what are some of the most inspiring things you’ve seen?
Going to a National Immunization Day is a wonderful experience. You see Rotarians really turned on, working with the community. Watching the children line up, for example, in India at a vaccination booth, and seeing all these little kids, being so good. They just stay in a line; they hardly say a word. The bigger sisters bring the little ones. The sad thing about it is, you can look at the back of the crowd, and some of the kids are disabled, wearing braces – those for whom we were too late, who, unfortunately, didn’t get the vaccine before they got polio. It is that picture in my mind which makes me, more than anything else, determined not to give up and to ensure as best I can, as chair of the Board of Trustees and the International PolioPlus Committee, to remind all Rotarians of the promise we gave to the children of the world: to eradicate this evil disease forever.

How you can help
Rotary clubs, districts, and individual Rotarians can help reach Rotary’s goal of a polio-free world by donating to PolioPlus Partners. This Foundation program supports the immunization activities of Rotary and its worldwide partners, including the U.S. Centers for Disease Control and Prevention, UNICEF, and WHO, in polio-endemic and high-risk areas. Check out the list of projects, and contribute.