On Tuesday, the world celebrated a rare piece of good news from 2020: The World Health Organization (WHO) announced that the wild poliovirus has been eradicated from Africa.
The milestone comes after three years without a single case of wild polio recorded anywhere on the continent (there are still so-called vaccine-derived cases circulating – more below). It brings us one step closer to the worldwide eradication of polio; that achievement, however, is still a way off.
The eradication of a major disease is enormous news, and it is not just an event. In the 1970s, the world came together in a concerted global campaign to eradicate smallpox, which was officially certified by the WHO in May 1980. It was an enormous achievement, both for global public health and for the power of countries that working together on one of the world’s biggest problems.
But it’s one we did not duplicate in more than 40 years ago. Efforts to eradicate diseases are based on both technical and political difficulties. In polio’s case, the disease is harder to destroy than smallpox, because in rare cases the vaccine can give rise to a case of the disease. Meanwhile, the cause of polio eradication was dealt with in the 2000s when the CIA, during the Obama administration, used a fake vaccination program as part of an effort to track down Osama bin Laden.
The WHO announcement Tuesday is a reminder that progress is continuing, albeit at a bumpy, frustrating and sometimes disappointing pace. And while eradicating diseases can be difficult, global scale coordination is needed, it’s easy to feel pessimistic about these days, it’s achievable – and worth the effort. Once a disease is out of the world, we will never have to spend more on public health resources. It can never take or change another life again, allowing humanity to advance to the next goal on the list.
The global fight against polio, explained
Polio is caused by a virus, usually contracted in childhood, and often results in paralysis and can lead to dea.
In the early 20th century, massive outbreaks of polio broke out in the United States and around the world. One outbreak in New York in 1916 caused 9,000 cases and 2,400 deaths, mostly of children. Scared New Yorkers, unsure of what caused the virus, engaged in mass killings of cats and dogs believed to be transmitting the disease. (They also took more sensible measures to combat the spread of a contagious virus, such as closing schools and cinemas.)
By the 1950s, we understood polio a little better, and researcher Jonas Salk had developed a vaccine that he thought would be safe and effective against the disease. In 1952, a devastating outbreak in the US saw nearly 58,000 cases and more than 3,000 deaths. The following year, the vaccine was introduced in one of the first large-scale, randomized controlled trials in history: 1.83 million American children received the vaccine as a placebo.
Studies showed that the Salk vaccine worked. Other researchers are developing a more effective vaccine that can be administered orally instead of injected, making it easier to use on a mass scale. The outbreak of the country was halted, and by the 1970s the plague of polio was almost gone from the US. At the same time, the war was going on worldwide, and more and more countries were expelling the disease off their coasts in the 1980s and 1990s.
But there was a complication, albeit a mild one. The oral polio vaccine contains a live virus, which can (very, very rarely) mutate back into a harmful form, causing the vaccinated child to become ill. This is estimated to occur approximately once in every 2.7 million doses.
And if a vaccinated person with a mutated transmissible form of the virus lives in an area with very low vaccination rates, the virus can start circulating in the community again. This is even rarer. Since 2000, 10 billion vaccine doses have been administered, and there have been 24 outbreaks of circulating poliovirus derived from vaccine. Adequate vaccination makes these outbreaks impossible, because the mutated virus does not get the chance to circulate in the first place. But this scary side effect, although exceptionally rare, has led to fears of vaccination in some developing countries, such as viral misinformation about other side effects and rumors that it is a Western plot to sterilize Muslims.
All of this has made eradication more complicated. Tuesday’s statement specified that the wild poliovirus had not been detected on the African continent for three years – but the continent has still received outbreaks of poliovirus by vaccine. For true extermination, we must stamp it out as well. In recent years, the global eradication has decided to switch from oral vaccines to injecting vaccines, which have no risk of mutating the virus.
Paying the price of a fake fax campaign
The other barrier to global extinction is the prevalence of polio in rural Afghanistan and Pakistan. Efforts in those areas have not been extensive enough to keep a lid on the virus.
For a long time, vaccination in that region was hampered by poverty, suspected aid workers, and persistent violence. During the Obama administration in 2011, the Guardian reported that the CIA was trying to confirm bin Laden’s location with a false vaccination campaign against hepatitis to obtain DNA samples that it hopes will confirm the identity of his children in a Pakistani connection.
The effects of this fraud on polio eradication in the area were catastrophic. Local militants began attacking health workers who provided polio vaccines, suspecting they were American spies. International aid organizations were forced to stop their vaccination operations.
Polio cases speak for themselves. “Release of this information has had a devastating effect on global eradication of infectious diseases, particularly polio,” read a 2014 editorial in the Lancet medical journal. “News of the vaccination program led to a ban on vaccination in areas controlled by the Pakistan Taliban, and added to existing skepticism about the sincerity of public health efforts by the international health community. Thus, the WHO declared that polio re-emerged as a public health emergency in Pakistan. ”
The White House later stated that the US would stop using fake fax programs for espionage, but the damage was done. In the coming years, at least 70 polio fax workers were killed in the region. To this day, the Taliban ban polio vaccination and shoot health workers who try to deliver it. There has been no responsibility for the Obama administration’s decision to authorize a false program for military purposes, and public confidence in the region has not been restored.
A combative extermination effort that is still worth fighting for
This year, the ongoing fight against the poliovirus was further complicated by fears of the spread of the coronavirus, which halted many of the world initiatives for public health against polio. “We did not want the program to be responsible for aggravating the situation with Covid-19,” Michel Zaffran, head of the WHO’s Global Polio Eradication Initiative, told April Magazine. But without vaccination, polio recurs rapidly.
“The numbers look terrible for eradication,” said Hamid Jafari, who led the WHO’s polio eradication efforts in Pakistan and Afghanistan in July. With both wild polio and vaccine-derived polioviruses circulating, and with little immunity to the latter, affected regions could see vaccine-derived polio “rising to the thousands of cases if we do not intervene,” Jafari added.
Vaccine-derived polioviruses are also circulating throughout Africa, and attempts to keep a lid on outbreaks have been hampered by coronavirus-related breaks in polio response. The milestone announced by the WHO on Tuesday is real, but in many ways this year was a setback for polio eradication.
Despite all these challenges, there is something important to celebrate here. A century ago, the world was devastated by a terrible disease about which we understood nothing. It focused on children, killing them or paralyzing them for life. In the century since then, we have learned how polio works and how to combat it.
We embarked on a breathtakingly ambitious campaign to ensure that it would never kill a child again.
And while we are not quite there, the extinction of wild polio from the continent of Africa is a real cause for celebration. “It is a vivid reminder that faxes work and that the collective actions of communities, governments and partners can bring about tremendous change,” said Drs. Matshidiso Moeti, WHO Regional Director for Africa, in a call from Zoom announcing the news.
Sometimes – despite our mistrust and suspicion, and despite wrongdoing by government and violence by militants – we can make the world safer for children. We can be proud of that, even if we are careful not to underestimate the work ahead.
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