Gates Foundation on polio eradication dance: Two steps forward, one step back

Children disabled by polio begging in Abuja
Children disabled by polio begging in Abuja
Mike Urban

On the whole, there’s been a lot of good news lately about the global campaign to eradicate polio — a significant reduction in reported cases so far this year, new money pledged to the effort and a recent announcement by the Taliban in Afghanistan that it would stop trying to kill polio workers.

In the past week, however, we’ve had a few setbacks in the polio campaign including an attack by the Pakistan Taliban on polio workers and two outbreaks of polio in parts of Africa, Kenya and earlier in Somalia, previously free of the insidious, infectious disease.

As NPR reported, these all pose a Threat to Global Eradication. Quoting an expert at the WHO:

(These) handful of infections with poliovirus has the potential to set back global efforts to eradicate polio …  “Polio is a virus that spreads silently … One case represents between 200 and 1,000 people infected. It’s the tip of an iceberg.”

Kenya had been free from reported polio cases for nearly two years. Somalia hadn’t had a case since 2007. Nigeria is the likely source for these new cases in Africa, with Pakistan and Afghanistan being the only other two ‘endemic’ countries keeping polio alive.

Because of lower polio vaccination rates in some neighboring countries, as Scientific American recently reported, some are concerned these apparently isolated outbreaks could spell doom for the goal of polio eradication.

Apoorva Mallya
Apoorva Mallya

The outbreaks are cause for concern, says Apoorva Mallya, but less so than might have been the case a few years ago.

As senior polio program officer for the Bill & Melinda Gates Foundation, Mallya has the crucial if perhaps unenviable job of working for one of the most powerful and performance-based ‘impatient’ philanthropists on one of his biggest causes, polio eradication, which has progressed like a hiker climbing a steep scree of loose rock — two steps forward, one step back, whoops….  A chat with Mallya given these recent setbacks:

Q So has the last week or so put a dent in your impatient optimism about the goal of ridding the world of polio by 2018?

AM: I don’t want to downplay these events, but the way to look at this is we are going to continue to have these kind of outbreaks so long as polio is endemic in these three countries. It’s inevitable so we shouldn’t be surprised.

Q But how can we be any more confident that this half-century history of whack-a-mole (i.e., the global effort to eradicate polio) is ever going to end? What’s different about the effort today?

AM: To begin with, we have a new plan and approach that has so far had a great track record of stopping outbreaks. In 2010, the global community agreed to a much more aggressive strategy aimed at stopping outbreaks like this within six months. It can take anywhere from three to ten (vaccination) campaigns in the effected areas, but so far we have been completely successful at stopping these outbreaks from spreading. That’s new.

Q What else is new? Why set this goal of eradication by the year 2018?

AM: We didn’t set the year 2018 and work backward to come up with what we hope to do in five years. We arrived at 2018 by establishing a specific strategy for stopping transmission in endemic countries, which included this more aggressive response to outbreaks and better surveillance. We have never done that before, and we’re close. The key to this whole thing is stopping transmission in these countries.

Q One of the keys to stopping transmission is to stop using the oral polio vaccine, since it has the unfortunate tendency to sometimes cause polio. Why not stop using that vaccine now and just use the injectable vaccine?

AM: That’s the long-term goal. But the oral polio vaccine is still useful while we are in the phase of stopping transmission. It’s very effective, cheap and easy to administer. You can reach a lot of people with this vaccine that you might not be able to do so easily with injectable. But once we can certify that we’ve stopped transmission in these countries, we can get rid of the oral vaccine and only use the injectable.

Q Any thoughts on the Taliban targeting polio vaccinators, which some say is a consequence of the intelligence services posing as aid workers in Pakistan?

AM: In Afghanistan, with the recent announcement by the Taliban there, we’re confident of making progress. In Pakistan, it’s a bit more tricky. But that’s part of the reason we held the Vaccine Summit in the Middle East. I think we’re making progress there.

Children in northern Nigeria receive oral polio vaccine
Children in northern Nigeria receive oral polio vaccine
Bill & Melinda Gates Foundation



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Tom Paulson

Tom Paulson is founder and lead journalist at Humanosphere. Prior to operating this online news site, he reported on science,  medicine, health policy, aid and development for the Seattle Post-Intelligencer. Contact him at tom[at], follow him on Twitter @tompaulson and/or send a comment below.