While the number of polio cases is at a historic low, new obstacles are delaying global eradication.
The three remaining endemic countries – Afghanistan, Nigeria and Pakistan – are hampered by insecurity that makes it difficult to vaccinate all children against the disease. And a vaccine shortage expected to be resolved this year will extend into 2018. Despite the challenges, health officials with the U.N. are optimistic that the end is near for polio.
“Eradicating polio will be one of the greatest global health achievements in history,” UNICEF Director of Polio Eradication Reza Hossaini told Humanosphere. “It will not only show it is possible to have a world free of polio, but it is possible to reach every child living in this world with other services.”
The number of cases reported in the first quarter of 2017 was half compared to the same period last year. And polio officials no longer detect the Type 2 and Type 3 polio strains, leaving one strain in existence. It brings the world closer to phasing out the use of the oral polio vaccine. This is important because it contains a live form of the virus, which has the potential to spread.
However, the return of polio to Nigeria last year was an unexpected setback. The government reported that two children were paralyzed by polio in August 2016, just as the country celebrated two years polio-free. Health workers and vaccine campaigns have been unable to reach some communities there that have been cut off by Boko Haram.
With Boko Haram driving people out of their communities, there is the possibility that those people could carry polio to neighboring countries. Some 23,000 front-line health workers are deployed in Lake Chad Region to vaccinate up to 94 million children, Hossaini said.
Countries in the region are trying to work together to prevent new polio infections. That requires launching vaccine campaigns at the same time so people traveling across borders are not missed. It is similar to the coordination necessary between Pakistan and Afghanistan. The few cases in the two countries are found along their shared border.
Pakistan launched an immunization campaign on Monday that aims to reach more than 37 million children. Officials said the campaign is critical since it takes place during the period when infections are less frequent. Only two cases were recorded in the first quarter of the year, down from eight over the same period last year. The campaigns help prevent cases and draw the country closer to eradication.
“We are about to defeat polio,” Rana Safdar, the national coordinator for national emergency operation center, said in a statement.
The effort by the health workers stands in contrast with the response by some government doctors. A senior health official told Pakistani newspaper The Express Tribune that more than a dozen doctors and government workers refuse the vaccine for their children. Health authorities maintain a list of households where children are vaccinated to monitor its effort to reach every child under 5 years old.
The World Health Organization (WHO) and other partners worked with Pakistan to launch what they called a “conversion drive” ahead of the vaccination campaign to change the minds of families that refused the vaccine in the past. There are early signs of success for the effort. Peshawar’s Additional Deputy Commissioner told the Tribune that parents to at least 47 kids were convinced to accept the vaccine.
Health workers are a crucial part of the effort in the three endemic countries. The inclusion of women was a major breakthrough for Pakistan, Hossaini explained. Women were able to reach more people taking the campaign from “door to door” to “room to room,” he said.
That helped to reduce the refusal rate to roughly 0.1 percent in Pakistan. Continued efforts to reach people help ensure that clusters of unvaccinated communities or neighborhoods do not emerge. The health workers go out into communities despite the risk of attack by the Taliban or Boko Haram, both groups who oppose vaccines.
“A lot of the work is being done by the front-line workers in three dangerous parts of the world,” Michel Zaffran, director of polio eradication at the WHO, told Humanosphere. “We should recognize the work being done by these front-line workers is remarkable. And we should recognize that they are risking their lives to ensure children are being vaccinated.”
There is another fundamental problem for the global effort – not enough vaccines. There is not enough of the inactivated polio vaccine, 35 countries have shortages. It is more expensive than the oral version but extremely effective at protecting people against polio. The WHO said last year that it would fix the problem by 2017, but Zaffran said that production issues persist and he does not expect to restore the supply until next year.
To deal with the shortage the WHO is allocating the vaccine to countries based on the greatest risk of a Type 2 outbreak. As that issue is being addressed, the WHO and UNICEF are focusing more work on surveillance to detect polio cases in people and the environment. Lack of access and underdevelopment pose challenges for health workers to monitor parts of Nigeria, but an effort is underway to gather as much information as possible.
Despite the challenges, the effort for eradication persists.
“The closer we get to eradication the more important it is to double down on our efforts and cross the finish line,” Zaffran said.
