The Center for Disease Control and Prevention (CDC) has called it “one of the most feared diseases of the twentieth century.” Mainly affecting children under five years of age, Poliovirus can infect the nervous system and cause long-term or permanent paralysis. In extreme cases, it can lead to death by paralysis of lung and heart muscles. President Franklin D. Roosevelt was a victim of this disease among many others. Medical research thus far has been unable to find a cure for polio; the disease can only be prevented by vaccination. The immunization process, however, can be done with minimal side effects, and it will only cost $0.50 per vaccine according to The United Nations Foundation. Nonetheless, even with these measures easing the process, polio has not been eradicated. Understanding the cultural and regional roots leading to this outcome may serve in the solution to rid the world of polio effectively.
The global health battle against polio officially launched in 1988, when the CDC, World Health Organization (WHO), UNICEF, and the Rotary Foundation began the initiative of eradicating polio in highly endemic countries such as India and parts of Africa. Since then, according to the WHO, this process has been so successful that the disease was reduced by 99%, from a starting number of 350,000 cases in 1988 to 223 reported cases in 2012. Nigeria, Afghanistan, and Pakistan are the three remaining countries that have not overcome polio. Disturbingly, during the past summer, there were reports of polio outbreaks in Somalia and Kenya. More recently, another polio outbreak occurred in Syria, sparking concerns over the possibility of viral transmission by the refugees into continental Europe.
Currently, prevention through vaccination stands as the only means to eradicate polio. Many factors, however, have come in the way of eradication. The bulk of these issues revolve around the absence of support from religious leaders, as well as the geographic turmoil surrounding the three mentioned reservoirs. Understanding and addressing these obstacles remains the sole way to effectively eradicate polio in the future.
Roots of Eradication
Citizens of Afghanistan and Pakistan hold mixed emotions towards America’s global health initiative. On one hand, the United States military has carried out numerous operations in these lands with little regard for the ramifications of such actions on the civilian population. With the increasing number of drone strikes targeting terrorist groups, ordinary citizens have become angered with America’s military intervention. On the other hand, U.S. provides the highest proportion of global health funds among other nations. A portion of this funding is allocated to eliminate endemic diseases such as polio. Additionally, in cooperation with private organizations such as the Bill and Melinda Gates Foundation, a strong effort has been made to provide vaccination to Middle Eastern Countries such as Afghanistan and Pakistan.
In many cases, the mistrust towards Western countries outweighs the eradication effort. For example, in an extended report by Donald McNeil of The New York Times, a number of individuals refrained from vaccinating their children since it was made public that some of the immunization camps were set up as cover for a Central Intelligence Agency (CIA) operation. Undoubtedly, convergence of military agenda with global health initiatives has been a drawback in providing vaccination for Afghani and Pakistani citizens. Moreover, religious factors play a significant role in making vaccinations accessible. With the influence of anti-Western religious institutions, many immunization camps have been forced to withdraw by local organizations in power, for a multitude of reasons including the continued drone strikes.
In many situations, the issue has not been the availability of vaccines, but assuring the public that immunizations are in fact for the good of the people being vaccinated. According to a report by The New York Times, health care providers had to fight the rumors that polio vaccines contained HIV or birth control hormones. A combination of these rumors along with people’s mistrust towards Western countries has resulted in the undermining of eradication efforts.
A small but notable percentage of those not currently vaccinated come from regions without access to purified water. Bad sanitation habits have caused the sewage being mixed with clean water pipes, allowing for spread of polio and many other viruses that target the population utilizing that singular source of water. This is one of the few examples indicating that eradication will not be successful solely through vaccination.
Recent Outbreak in Syria
A number of other factors need to be addressed simultaneously in the fight against polio. Less than a month ago, multiple reports indicated the emergence of polio in Syria; a country beset with internal conflicts that have led many to flee and seek refuge in neighboring countries. Such movements have caused the spread of the disease from one country to another. It is estimated that the virus entered Syria through Pakistan in this manner.
Although, as noted in a report by Reuters, the United Nations is taking prompt measures to prevent further spread of the virus, it is imperative to keep in mind that polio was eradicated in Syria fourteen years ago. The civil conflict over the past few years has crippled many health-care functions including vaccinations, allowing polio to regain its foothold within the country
In addressing Syria, the international community should direct its attention to the health concerns of civilians both inside the country and within the refugee camps. If unattended, not only will this lead to further fatalities, it will also facilitate the virus finding its way to other continents such as Europe.
Hope for Progress
The international fight against polio has come a long way since it started in 1988. One of the most influential battles throughout this period was the successful eradication of the virus in India in 2011. Being one of the most challenging countries to eradicate polio in, this success paved the way for the current global eradication movements. In its annual report, The Global Polio Eradication Initiative (GPEI) brings examples of successful methods in effective vaccination throughout India. Such strategies include strong collaboration between physicians and local religious clerics, as well as continued sampling of the sewage systems in high-risk areas to keep a constant lookout for the presence of the virus.
In the long history of conflict and rivalry between India and Pakistan, eradication of polio in India was seen by some as a triumph for India and a great tragedy for Pakistan. This event, however, has mobilized both Pakistani citizens and health-care providers to promptly address this issue and work towards being the next major international state to have polio eradicated.
The current trajectory of polio immunization aims to have polio completely eradicated by 2018. This goal, however, will only be successfully reached with the simultaneous collaboration of immunization efforts between the global community and local communities alike. Consistent supervision of eradicated sites with incorporation of other essential efforts such as the provision of purified clean water, mean that eradicating polio could well become the most successful global health effort of this century.
Facts and figures from CDC, WHO, Global Polio Eradication Initiative, The UN Foundation, The New York Times, The Washington Post, Reuters, BBC, and The Wall Street Journal
Erfan is a fourth year undergraduate student at UCLA majoring in Molecular, Cell and Developmental Biology and Minoring in Near Eastern Languages and Cultures. He is involved with Shot at Life, a global health organization under the umbrella of the United Nations Foundations that advocates for vaccination in developing countries.