The multibillion-dollar global effort to eradicate polio hasn’t just stalled. It’s moving backward.
When the Global Polio Eradication Initiative began in 1988, roughly 350,000 kids a year were paralyzed by the virus. By 2016 that number had been driven down to 42 cases of any type of polio anywhere in the world.
But now cases are on the rise and expected to climb even further in the coming months. So far this year officials have tallied more than 200 cases of wild polio and nearly 600 cases of the vaccine-derived form of the disease. Most of the vaccine-derived strains of polio are in Afghanistan and Pakistan, but now these rogue strains of polio are also turning up across much of sub-Saharan Africa, Yemen, Malaysia and the Philippines.
Vaccine-derived polio is caused by remnants of earlier versions of the live virus used in the oral polio vaccine. The vaccine can be shed through feces. In places with poor sanitation, the vaccine can be spread through wastewater. Over time, the virus from the oral vaccine can replicate, regain strength and become just as virulent as the original virus against which it’s supposed to protect.
And worst of all most kids born after 2016 have no immunity to the most prominent vaccine-derived polio strain because that strain was thought to be on the verge of elimination and is no longer included in the primary oral vaccine they would have received.
What’s more, millions of children have not received vaccines because of conflict and lack of access in Taliban-controlled areas of Afghanistan and Pakistan plus pandemic lockdowns.
“2020 has been a terrible year and will continue to be a terrible year,” says Michel Zaffran, head of the Global Polio Eradication Initiative at the World Health Organization in Geneva.
The pandemic is part of the problem. In March, WHO ordered a pause to all polio eradication campaigns to make sure vaccinators going door to door weren’t unwittingly contributing to the spread of COVID-19. That order was lifted over the summer, but “as a result, 30 to 40 countries have not conducted mass immunization campaigns,” Zaffran says. “During that period, up to 80 million children have been left unprotected against polio.”
The fear is that with so many children now susceptible to polio, outbreaks could erupt, particularly in areas with poor sanitation where the virus can thrive.
And then there’s the role the Taliban have played in stymieing vaccination efforts. “For the last 28 months, there was a ban on polio activity in the southern provinces controlled by Taliban,” says Mohammedi Mohammed, head of immunization for UNICEF in Afghanistan.
“Twenty-eight months! It’s enormous,” he says of the amount of time that vaccinators have been barred by the Taliban from doing door-to-door polio vaccination drives. “If we continue like this, soon we will have three years of children that were born but not vaccinated. So we are building up the susceptibles for a mega-outbreak.” And there’s no sign that the Taliban are going to lift the ban.