Gains In Polio Eradication Fight At Risk Due To Immunization Gaps
Representatives from Rotary International and the government of the Philippines sign the agreement that starts Rotary International’s first polio project, 1979.

A historic window of opportunity to eradicate polio could be slipping away, World Health Organization (WHO) Europe leaders warned at a press conference marking World Polio Day on Monday. 

Since the 1980s, global polio cases have fallen by 99.9% and if polio were to be eradicated, it would join smallpox as only the second disease to be consigned to history.

“Polio is on the verge of becoming a story of the past,” said Dr Hans Kluge, WHO Europe Regional Director. “We stand on the cusp of eradicating the virus, but progress and the European region’s polio free status remain vulnerable.” 

The European region has been free from wild polio for two decades. But over the past year, circulation of vaccine-derived polio virus – a strain mutated from the weakened virus contained in the oral polio vaccine – has been confirmed in Israel, Ukraine, and the United Kingdom. This weakened variant can only spread in pockets of under-immunized communities, highlighting the need to reinforce vaccination efforts.

“The fight against polio has demonstrated the wonders of immunization, but this is not something we can take for granted,” Kluge said. “We are so close to the prospect of a polio free world. Choosing to leave the fight now would be a tragedy for future generations.”

Journey to eradication: from dream to reality

The 1979 agreement between Rotary International and the Philippine Ministry of Health for a joint multi-year effort to immunize children against polio

In 1979, a member of Rotary International issued a challenge to their peers in the Philippines chapter to eliminate polio from the island nation. It would take years of work, but the initiative was successful. The last case of wild polio in the Philippines was recorded in 1993. 

The challenge was then put to Rotary’s 1.4 million members globally. With representatives in over 200 countries, the goal became global eradication of the disease. Since the start of the 1979 vaccination campaign in the Philippines, Rotary International has invested $2.6 billion in the fight against polio.

“The thought was ‘if we can do it here, can we do it everywhere?‘” explained Rotary international president Jennifer Jones in her opening statement at the Monday press conference. “We started to speak with health professionals and organizations around the world, but it wasn’t seen as being a possibility at all.”

In 1988, the WHO, UNICEF and the Centers for Disease Control and Prevention, came together to form the Global Polio Eradication Initiative (GPEI). Later, the Bill and the Melinda Gates Foundation joined and GPEI became the largest international public health initiative in history.

Just last week, GPEI secured $2.6 billion in commitments at the World Health Summit, which is over half of its funding target of $4.8 billion set out in its 2022-2026 Strategy. This money is needed to provide vaccinations and essential healthcare services to over 370 million children worldwide. In total, over $19 billion has been invested into the programme since its launch.

The global effort has led to a reduction in polio cases by 99.9%.  “We are closer than we’ve ever been,” Jones said.

Endemic regions making progress

The mountains of North Waziristan, Pakistan.

Two years ago, wild polio was eradicated from endemic reservoirs in India and the African continent, and efforts in the last two endemic countries – Pakistan and Afghanistan – are trending in the right direction. But with the finish line in sight, the last mile is proving difficult.

“Pakistan has made incredible progress against polio, but recent challenges have allowed the virus to persist,” said Dr Zulfi Bhutta, professor at Aga Khan University in Pakistan. “Polio, like any virus, knows no borders; its continued transmission threatens children everywhere.”

Waziristan, a mountainous region of Pakistan on its Afghan border, faces high levels of vaccine hesitancy that have led to it becoming polios’ most resilient reservoir. The surrounding mountains – once strongholds of the Taliban – are a fitting backdrop for the disease to take its final stand.

The return of the Taliban from these very mountains to the levers of power in Afghanistan have complicated progress in reaching its unvaccinated communities. But negotiations to allow vaccinators better access to the country are underway.

Children pay the price of low-vaccination

Vaccine-derived polio strains are only a threat to the under-immunized. Too often, this means the heaviest burden falls on children.

“The occurrence of vaccine-derived polio around the globe clearly indicates one thing: we have left our children behind by not getting them vaccinated,” said Dr Siddhartha Datta, WHO Europe’s Regional Immunization Advisor. “It is extremely important that every child gets the vaccine doses which are part of the national vaccination schedule.”

Hundreds of children have already been paralyzed this year due to the spread of a vaccine derived strain amongst non-immune people in parts of Africa, Asia and Europe.

“Children deserve to live in a polio-free world, but as we have seen this year with painful clarity, until we reach every community and vaccinate every child, the threat of polio will persist,” said UNICEF Executive Director Catherine Russell. 

Polio anywhere is a threat everywhere

The re-emergence of polio in non-endemic regions highlights the difficulties of eradicating diseases in an increasingly interconnected world.  

“Polio is still a plane ride away,” Carol Pandak, the Chicago-based director of Rotary’s PolioPlus program told Bloomberg. “We’re sticking with the fight until we finish the job and keep our promise to the children of the world.”

But while cases in non-endemic countries are cause for anxiety, there is no need to panic, Jones explained.

“Seeing cases outside of the endemic areas is concerning, but we don’t need to fear-monger,” she said. “We should utilize the opportunity to raise awareness of what polio is and why it’s important to eradicate.”

COVID-19 has also taken a toll on polio immunization programmes. Across the WHO’s European region, coverage of the third dose of polio vaccine fell by 1% between 2019 and 2020. In 2021, only 25 out of 53 of the region’s countries had reached the 95% polio vaccination coverage rate recommended by the WHO.

“It is paramount that we ensure high vaccination coverage in all population groups,” said Kluge. “Until polio is eradicated, every country will remain at risk.”

COVID remains a threat, and forecasting is shaky

WHO Europe Director Hans Kluge at a press conference marking World Polio Day.

Last week marked 1000 days since the first cases of COVID-19 arrived in Europe. Entering the third pandemic winter, the continued evolution of the virus driven by a range of sub-lineages of the Omicron variant remains a concern.

An autumn surge has led to a tripling of cases in the European region since early September. In the second week of October, the region accounted for nearly 60% of new global cases and 42% of deaths.

“We are much better prepared, and the surge has not led to previous ICU admission or severe disease levels,” Kluge noted. “But the virus has surprised us more than once, and forecasting is tricky.”

WHO Senior Emergency Officer Dr Catherine Smallwood echoed the difficulty of projecting how the disease will develop through the winter.

“We’re having trouble isolating which of the omicron sub-variants will have a growth advantage and will take over in dominating the spread,” she explained. “Some variants like BQ.1 have been noted as potentially accelerated, but we’re not sure yet how this is going to pan out in the longer term.”

Image Credits: Rotary International, Rizwan Ullah Wazir.

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