7 May-2014, The Guardian: The World Health Organisation has declared a public health emergency as polio returns to countries that were free of it and calls on three governments to immunize adults travelling beyond their borders.
The heroic effort to rid the world of polio, which was looking so promising only a year ago, has hit a major setback. There have been plenty of disasters in the past – the most obvious being the appalling killings of vaccinators in northern Pakistan. The most recent of those was only last month and there have been at least 30 in the last two years. What is happening now may in part be a consequence of that, but is even more threatening to the ultimate goal of polio eradication – it is the drift of the viral disease back into countries that everybody thought were clear of it.
That is why the language used by the World Health Organisation this week has been strong and alarming. An emergency committee convened by director general Margaret Chan said the spread of polio so far this year has been an “extraordinary event” and a public health risk to other countries. WHO stated:
If unchecked, this situation could result in failure to eradicate globally one of the world’s most serious vaccine preventable diseases. It was the unanimous view of the committee that the conditions for a Public Health Emergency of International Concern (PHEIC) have been met.
The capital letters may look clunky but are not unwarranted and have already successfully triggered a helpful response from the Pakistani government. The WHO says it is adults who are taking the virus from one country to another and has called on the governments of three countries that it says are most likely to export the virus, Pakistan, Cameroon and Syria, to dose any travellers before they leave and ensure they have a certificate to prove it.
There are only three countries now where polio is endemic – Pakistan, Nigeria and Afghanistan. There were 417 cases of polio in 2013 and more than a fifth were in Pakistan. It is now in the spotlight. Bruce Aylward, the WHO assistant director general who has led their efforts on polio, says it is the main pool from which the ripples are spreading.
In the majority of these re-infected areas, the viruses circulating actually trace back to Pakistan within the last 12-18 months.
Perhaps a public health emergency will help Pakistan’s government with the political discomfort of putting measures in place that may upset some in the population. It is to be hoped that this will reduce the spread of cases. But there are other routes too. Wild poliovirus turned up in Cameroon again at the end of last year after two years with none. It came from Chad and may well have come from Nigeria before that. From Cameroon, it spread to Equatorial Guinea.
That sort of trail shows how difficult it is to keep polio in check – let alone eradicate it. There are now ten countries with recent polio cases and real anxieties about what will happen if it is exported into any more conflict-torn countries, like Syria, where blanket vaccination of children – the usual tactic – is very difficult. Immunisation at the airports will help, but the borders of many countries are porous, without passport check points, let alone polio drops.