The polio virus, as it is frustratingly inclined to do, has rebounded again despite the ongoing, determined effort aimed at worldwide eradication.
Like the game whack-a-mole, polio is popping up again in locations that we thought had gotten rid of it for good – like Israel or eastern Europe.
This happens because the virus is good at cloaking itself, sickening only about 10 percent of those infected and spreading primarily due to poor sanitation or hygiene (i.e., the highly unappetizing path of transmission known as the ‘oral-fecal’ route). But that’s the purely epidemiological, health-focused explanation.
The main driver, arguably, for the recent surge polio cases is conflict, instability and, of course, ongoing poverty.
Scientific American asks Does Israel’s new polio outbreak threaten global eradication efforts? No, not really. Israel, as a wealthy and functioning country, will likely succeed at nipping this outbreak (no human cases; just polio in the sewage) in the bud. The appearance of polio in Israel is more a symptom of what’s threatening the eradication effort. As SciAm reports, quoting WHO’s polio point man, Bruce Alyward:
This virus is very similar to a strain that was detected in December of last year in Egypt, in the sewage there. This original virus came from Pakistan. Whether it went into Egypt and then Israel or Israel and then Egypt or [whether it spread via]two separate importations—it is unclear.
Polio has also re-emerged in Ethiopia, as Voice of America reports, initially assumed to have come from an outbreak in Somalia but further testing has identified its origin in West Africa.
Pakistan, along with Nigeria and Afghanistan, are routinely given the shameful label of the world’s last three polio endemic countries. But endemic is a fairly imprecise word, which really only means polio is regularly seen in these countries. Borders mean nothing to infectious diseases so it is better to say polio just remains out there, in general. The New York Times also reports on the resurgence of polio, mostly in Africa, as a threat to eradication.
I appreciate NYTimes’ reporter Don McNeil reminding readers that Pakistan’s problem (and perhaps to some extent Nigeria‘s in the Muslim north) can be attributed in part to the CIA’s ill-conceived fake vaccine scheme there a while ago:
The new Pakistan outbreak is in North Waziristan, near the frontier with Afghanistan. It is in an area where a warlord banned polio vaccinations after it was disclosed that the C.I.A. had staged a hepatitis vaccination campaign in its hunt for Osama bin Laden. The warlord, Hafiz Gul Bahadur, banned all efforts until American drone strikes ended.
The Guardian’s report on the resurgence of polio in Pakistan and now Israel also mentions the CIA scheme and its unfortunate but predictable consequences (the Taliban or other anti-Western militants targeting polio vaccinators and other health workers). The spooks’ stupidity (or indifference to what their actions would do to aid workers) didn’t help matters, but polio was already a problem in Pakistan because Pakistan suffers from conflict, poverty and instability.
The world may yet defeat polio, but it’s important to recognize that the root cause here is chaos and poverty. Unless we are also working to eradicate those two drivers of diseases of poverty, we’ll just have to keep doing whack-a-mole with a new and different mole.
Afterthought: One contrary (to my thesis) and positive indicator is that the world seems to be getting more chaotic – at least as this cool interactive map seems to show – while polio case numbers have been brought way down over the last few decades, thanks to many dedicated vaccine workers supported by Rotary International and, lately, the Bill & Melinda Gates Foundation. But I still think polio is a proxy for chaos.