The end of polio is near(ish)

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

With only 22 cases of polio last year and nine cases in 2016, the end of the virus is nearly here. It is possible we could see the final case ever within the next year, the World Health Organization’s director of polio eradication told the Guardian today. With so few cases in recent years and improved vaccination campaigns, the end may really be near.

But we’ve heard this before. For years, dates have been bandied around and targets set for eradication. Crossing the finish line has proved to be a difficult task, especially given the challenge of vaccinating children in Pakistan and Afghanistan – where vaccine volunteers are regularly attacked.

The polio eradication effort started in 1988 with the aim of reaching zero cases of the wild form of the virus by 2000. Experts were skeptical given the fact that prior initiatives failed to achieve their eradication goals, such as the push against malaria starting in 1955 and against measles in 1977. Nevertheless, the rush was on to end the virus that paralyzed about 250,000 children a year.

Major gains were made over the next decade, but the effort failed to reach its 2000 goal. The campaign gained wider attention when the Gates Foundation joined the eradication push in 2005. Billions of dollars were injected into the effort in recent years – far exceeding the financial contributions of groups like Rotary International. As time went on and the difficult task of finishing the last mile dragged on, the projected end dates kept pushing out.

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The foundation put forward $1.8 billion in 2013 with the hopes of eradicating polio by 2018. Last year, Gates said the virus may be eradicated by 2019 and earlier this year he raised the possibility that the last case could be seen this year.

“We need some good execution and a little bit of luck,” Gates said at the World Economic Forum in January.

Right now the effort is seeing some good luck. Pakistan has managed to prioritize and reach areas of the country where children have not previously been vaccinated. Afghanistan is conducting vaccinations at transit points in order to protect children living in areas not controlled by the government. The two countries announced a plan earlier this month to work together on providing vaccinations in the face of Taliban opposition to campaigns.

But this does not mean all is clear. Even when cases are eliminated, it is possible for flare-ups. That is especially the case in countries where unrest and violence can cut off basic health services. Iraq, Nigeria and Syria all had cases return in 2013 after achieving eradication. Instability in Iraq allowed for cases to emerge and then cross into Syria as it dealt with its ongoing civil war. Similarly, the return of polio to Mali and Ukraine came as the countries dealt with fighting.

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“When ‘gaps’ in immunization occur, the virus can continue to circulate from person to person. In addition, since the virus can be spread through feces, if there’s inadequate sanitation, sewage mixed with the water supply might be another possible route for transmission,” WHO polio communications experts Oliver Rosenbauer and Leilia Dore told NPR last year.

Polio cases in Pakistan are down significantly from last year. The seven reported cases in 2016 are more than half as many as the 20 reported over the same period last year. Afghanistan is roughly at the same point with two reported cases. Both countries have yet to record a new case since mid-February.

After more than $10 billion spent on ending polio, the end may be here. But as Yogi Berra once said, “It ain’t over till it’s over.”

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Tom Murphy

Tom Murphy is a New Hampshire-based reporter for Humanosphere. Before joining Humanosphere, Tom founded and edited the aid blog A View From the Cave. His work has appeared in Foreign Policy, the Huffington Post, the Guardian, GlobalPost and Christian Science Monitor. He tweets at @viewfromthecave. Contact him at tmurphy[at]humanosphere.org.