Global health advocates celebrate polio milestone despite disease resurgence

Pakistani policemen stand guard as a health worker gives a child a polio vaccine in Karachi, Pakistan, Sunday, March 9, 2014.
Pakistani policemen stand guard as a health worker administers a polio vaccine in Karachi, Pakistan, March, 2014.
AP

This week, the World Health Organization certified that India and Southeast Asia was ‘polio free.’

Significant progress has been made against this crippling disease, with 80 percent of the planet now free from polio thanks to an aggressive global vaccination campaign largely led for decades by WHO, UNICEF, Rotary International and more recently supported – both financially and from the bully pulpit – by the Bill & Melinda Gates Foundation.

There is indeed cause for celebration, but also alarm.

As CNN reported, the simple fact that India – not that long ago home to the world’s biggest polio epidemic – apparently has succeeded in ridding itself of the disease is counted as a major global health success story.

“This is a momentous victory for the millions of health workers who have worked with governments, nongovernmental organizations, civil society and international partners to eradicate polio from the region,” said Dr. Poonam Khetrapal Singh, WHO’s main man for SE Asia.

Bill Gates, as quoted in The Telegraph which was quoting from the Hindustan Times (which I am now quoting – see how that works?), said India’s elimination of polio represents “the greatest global achievement I have ever witnessed.”

We all like success stories. But the ‘other’ story here, unfortunately, is that polio is making a comeback in other parts of the world – in a way that almost certainly means eradication of this disease is even further off than it had been just a year ago.

As the photo above shows, Pakistani polio vaccinators and health workers now need to operate under armed guards because they have become targets of Islamist extremists. This is thanks, arguably, to the CIA’s incredibly ill-advised fake vaccination scheme in Pakistan in 2011 that pretty much confirmed the conspiracy theories many anti-Americans overseas hold – that aid workers are often spies – and pretty much guaranteed making health workers targets for assassinations.

Is it foreign aid or covert aid?
Is it foreign aid or covert aid?
Flickr, johanoomen

The CIA’s ruse, aimed at locating Bin Laden, was widely condemned by the humanitarian community. Here’s a similar rant from Laurie Garrett, a global health expert at the Council on Foreign Relations. Many were outraged back then, but there was nary a peep from President Obama or anyone in Congress. What’s losing a few aid workers compared to getting Osama Bin Ladin?

To make matters worse, Hollywood’s Zero Dark Thirty movie furthered the deadly association by even more strongly emphasizing (and misrepresenting, actually) the connection between the CIA and the polio campaign.

As a result, as The Guardian noted in a disturbing story about the recent murder of one polio vaccinator, scores of women (they are mostly women, aka the “Lady Health Workers”) who are trying to stamp out polio by offering immunizations in parts of Pakistan are instead living in fear for their lives. In the past year or so, more than 40 of these health workers in Pakistan have been murdered.

Health workers in Nigeria have been similarly targeted for assassination or abuse by Islamist extremists.

Polio remains endemic in Pakistan and this literal war on vaccinators bodes ill for reducing the burden of the disease. Meanwhile, polio has spread to Syria, where it had been eliminated prior to the civil war, and has also shown up in Iraq and again in East Africa. Instability and conflict, as much as the shit-borne virus itself, are contributing to polio actually expanding its global footprint again.

CDCpoliomap
CDC

Afghanistan and Nigeria, like Pakistan, have never rid themselve of polio and are also classified by WHO as endemic. The virus also showed up in Egypt and Israel last year, in testing done on sewage.

It should be emphasized that the designation of countries as endemic as well as the WHO certification of countries as ‘polio free’ doesn’t really correspond to the reality of this infectious disease. Only about one in 100 people infected with polio get sick or show symptoms. But they can still spread the virus. Given this, celebrating achievements made within national boundaries (sorry, pun alert) borders on the delusional. Polio is truly a global threat.

The fight against polio since the 1980s, when there were hundreds of thousands of polio cases, has gotten us to where we are today – battling just hundreds of cases in a few select locations. The international community has been spending about a billion dollars a year toward eradicating polio, which this writer celebrated as a very good buy, and now looks set to spend even more.

Eradication of polio is within our grasp. But the trending lately should prompt alarm, not celebration.

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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]humanosphere.org or follow him on Twitter @tompaulson.