Polio Surge in Pakistan: A cautionary tale for global health

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Polio Surge in Pakistan: A cautionary tale for global health

A Mercy Corps field worker gives a woman a health shot in Pakistan. CASSANDRA NELSON/Mercy Corps.

On the 50th anniversary of Jonas Salk’s discovery of a vaccine against polio, the disease has faded from the headlines.

Ebola is the world’s health scare now -- the horrible symptoms, the grave death toll and ways to avoid exposure. Not long ago, polio made those headlines. But cases globally have plunged by more than 99 percent since 1988, from 350,000 reported cases to just 291 in 2014, as of late last month. In a major milestone, the U.S. Centers for Disease Control and Prevention (CDC) just announced the elimination of the second of three strains of wild polio.

But a flare-up in Pakistan proves that polio is not going quietly.

Unless it is eliminated entirely, the disease can surge back, as it has in Pakistan: New cases there just surpassed 260 this year, over four times the number at this time last year.

Pakistan, along with Afghanistan and Nigeria, is an ‘endemic’ country, meaning one that has never gotten a handle on polio. The trio are on a global health ‘black list,’ as the disease can spread from these countries to infect people in nearby regions with inadequate vaccination protocols.

On a positive note, the massive, internationally-coordinated effort to eradicate polio has seen recent success, particularly in Africa. For the first time ever, there has only been one case of wild polio reported in Africa in the last four months.

Meanwhile, endemic Nigeria is making major strides to get off the black list. The drastic drop in cases there, from 49 in 2013 to only six this year, is largely credited to an aggressive vaccination campaign in which public health officials go door-to-door every six to eight weeks and administer oral immunizations to some 10 to 20 million children under age five.

“Every child in [a house] gets vaccinated, even if they’ve had [the vaccine] 10 times before,” said John Vertefeuille, the head of the CDC’s polio eradication team for Nigeria, noting that this strategy helps ensure that no one is missed. Vertefeuille also said that under the revamped campaign, local government officials are held accountable for the vaccinations, which has helped improve management and resource allocation.

We’ve come a long way since the panic surrounding polio 50 years ago, thanks to a simple vaccination. But the importance of that vaccination can’t be dismissed. Pakistan serves as a cautionary tale, with domestic vaccination drives there being undermined by ignorance and violence. Militants have used the epidemic to strike at symbols of authority, suggesting the many anti-polio field workers are Western agents plotting to use immunization to sterilize Muslim children. Only a couple of weeks ago, four health workers were gunned down, bringing the death toll among polio workers in Pakistan to 65 in two years.

Militant and terrorist group activity have also forced many families to flee their homes, making it difficult to track down the displaced children for vaccinations. Refugees also spread the disease: The number of districts in Pakistan infected by polio more than doubled to 22 over the past year, and officials say the country has exported the virus to Afghanistan, China, Egypt and Syria. Meanwhile, political leadership is too consumed by power struggles and corruption to focus on the security crises that are compromising vaccination efforts -- one newspaper called the epidemic Pakistan’s “badge of shame.”

Unlike most diseases, complete eradication of polio is possible. If the virus cannot find an unvaccinated person to infect, it will die out completely. But this requires continued unrelenting vaccination campaigns, which carry an up-front cost.

The Global Polio Eradication Initiative, created 26 years ago through a partnership of the World Health Organization, the CDC, Rotary International and UNICEF, has prevented hundreds of thousands of cases with an investment of about $9 billion. But as the number of cases has shrunk, the bill to pay for them has ballooned, with the global initiative planning to invest up to $7 billion more by 2018. That’s over $2 billion per year over the next three years to stamp out just a few hundred cases.

But relatively speaking, stamping out polio is cheap. The disease primarily hits children under five years old, with about one in 200 infections causing the permanent paralysis often associated with the virus. Disease experts believe that vaccinations will have prevented 8 million cases of paralysis between 1985 and 2035, which figures out to $40-$50 billion saved on lifelong care. Responding to outbreaks as they happen is expensive as well, so eradication saves money there, too.

Finishing the job is financially practical, as well as a moral imperative. “The children of [Pakistan] should walk, not crawl,” said Rotary International’s Aziz Memon, whose organization is the largest private sector donor to polio eradication, committing over $600 million since the early 1980s. “We promised to end this, and we will.”

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