Polio, Your Days Are Numbered

This devastating disease still exists in just three countries. A new plan says it's possible to end it once and for all within five years.
A polio worker gives polio vaccine drops to a girl in Pakistan in December 2012. Pakistan is one of just three countries where polio persists. (REUTERS/Mohsin Raz)
Apr 15, 2013· 3 MIN READ
The Disease Daily is a publication from HealthMap at Boston Children's Hospital.

Earlier this month a bold challenge was issued: that a new plan would end polio, once and for all—wipe it clean from the planet by 2018. Called the Polio Eradication and Endgame Strategic Plan, the new plan was released on April 11, developed by the Global Polio Eradication Initiative, and signed by over 400 experts worldwide. Simply put, the document outlines the key strategies that will finally make eradication possible.

Why 223 Cases of Polio Still Matter

Poliovirus an be spread in several ways: direct, person-to-person contact; contact with infected mucus or phlegm; or contact with infected feces. While about 95 percent of people exposed to and infected by the poliovirus don’t develop symptoms, a small percentage of those infected will experience mild, flu-like symptoms, maybe fever, and stiffness in the neck and back. Less than one percent develop a severe infection. When they do, though, it is very bad: Because the poliovirus invades the nervous system, severe infections usually result in permanent paralysis, and, if the virus hits the respiratory system, the infection can result in death. There is no cure for polio.

As you probably know from biology class, Jonas Salk created a vaccine in 1955, and since then the polio vaccine has been part of the routine childhood vaccination schedule in the U.S. Children typically receive four doses of the vaccine before entering elementary school. While polio has been eliminated from most parts of the world, it still exists in Pakistan, Afghanistan, and Nigeria.

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The authors of the new plan called it a “step forward over previous eradication strategies.” How so? One big change is the scheduled phase-out of the oral polio vaccine (OPV) in favor of the inactivated polio vaccine, which is injected (IPV). The OPV has been shown to be more likely to cause polio than the IPV, although the chances of this happening are still extremely small.

The plan also calls for targeted vaccination campaigns (rather than mass vaccination campaigns, targeted campaigns focus on a specific population or group that may be more at risk of infection than others) and a scale-up of routine vaccination programs. In the future, governments could use the infrastructure developed for routine polio vaccinations to provide other health services, such as better care for pregnant women and new mothers and other vaccines.

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Experts believe the plan improves on past vaccination strategies because it specifically emphasizes the importance of community buy-in and involvement. In the past, suspicion about vaccines and campaign volunteers has been a huge obstacle to getting children vaccinated. Many parents in the three remaining countries are hesitant to let their children be vaccinated because they don’t know how the vaccination works or they think that their child has received too many doses. In Muslim countries, some people are concerned that the vaccines don’t comply with Islamic law.

A few extreme cases of suspicion have resulted in attacks on polio vaccine campaign workers. On April 9, a man working to protect campaign volunteers was shot and killed in Pakistan. A similar situation occurred in Pakistan in December 2012 when five women were killed. In Nigeria, nine vaccine workers were gunned down in February 2013 while working.

Some suspicion about the intentions of vaccine campaigns is not unwarranted. In July 2012, the legitimacy of public health campaigns was seriously threatened when it was revealed that the CIA had used a hepatitis B vaccination campaign as a cover for reconnaissance on Osama bin Laden in Pakistan. To ease this suspicion, the new Strategic Plan has called on religious and community leaders to sanction these campaigns. The new generation of campaigns will also be low-profile in order to protect health workers from future attacks.

Polio’s Final Strongholds: Where People Mistrust Vaccination

If the experts behind the Polio Eradication and Endgame Strategic Plan can overcome resistance from communities, they’re poised to finally eradicate polio by 2018. There were only 223 new cases of polio reported in 2012 and have only been 16 cases so far in 2013. India, a country where polio has historically been endemic, has seen no cases for the past two years.

The Global Polio Eradication Initiative team estimates that global eradication will cost $5.5 billion over the next five years. In the past, gaps in funding have slowed campaigns, resulting in lost time and resurging outbreaks. This time, they hope to raise the full amount of money needed before beginning the campaign. Expected donors include Rotary International, the Bill and Melinda Gates Foundation, and government aid.

Chuck Woolery, the issues director of the Global Health Council from 1995 to 1997, says polio eradication is worth the cost. “We can pay a little more now or pay a great deal more in economic and human costs later.”

Do you think we're finally on the cusp of eradicating polio everywhere?

--By Lauren Edmundson

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A version of this story appeared on HealthMap.org