The effort to eradicate polio globally faces new challenges
Despite significant advances, the emergence of more cases highlights the threat still facing children.
27 May 2022
Extraordinary advances have been made in the effort to eradicate wild polio in just a generation. The number of children paralyzed by the virus has decreased by 99 per cent since 1988.
There is no cure for polio. It can only be prevented. That prevention comes from a vaccine, which can protect a child for life. And still to this day, many children do not have that protection. From conflict and displacement to the healthcare disruptions caused by the COVID-19 pandemic, as well as vaccine hesitancy, there are many reasons why that gap in immunization exists.
And now, recent cases of polio are emerging globally that threaten the advances that have been made over the past three decades. This is where things stand today.
Pakistan and Afghanistan are the last countries where polio remains endemic. Beginning with Pakistan, where do things stand in terms of the effort to eradicate wild polio there?
Pakistan saw a landmark achievement earlier this year. In January, the country went an entire year without detection of a single case of wild polio. It was a significant milestone in the nation’s effort to eradicate the disease.
But the fight is certainly not over. In April and May, there were four confirmed cases of wild polio, in what’s a setback to the country’s progress.
It’s clear that some children in Pakistan remain at high risk from the virus. One of the reasons for that is the COVID-19 pandemic. Over the past couple of years, there have been disruptions to polio vaccination campaigns and routine immunization services, which has meant that some children have not received their polio vaccinations.
UNICEF and partners of the Global Polio Eradication Initiative are stepping up efforts, working with Pakistan’s government to launch catch-up vaccination campaigns. A lot of the focus is on communities that are close to the border with Afghanistan in western Pakistan, where there’s a larger population of displaced children who are at higher risk of contracting and spreading the disease.
In the city of Lahore, in eastern Pakistan, frontline polio workers have been going door-to-door, where they’ve been meeting with caregivers on their front steps and giving polio vaccines to children. After receiving their dose, the children will often show off their finger, marked with a purple pen to prove their vaccinated.
To increase the vaccination rate, building trust is crucial. Across Pakistan, UNICEF supported health workers and mobilizers are working tirelessly with local community leaders to reach vaccine hesitant families. There’s also a social media team that continuously monitors anti-vaccination misinformation that can spread, responding quickly to it with accurate information.
In Afghanistan, the country’s health systems have been on the brink of collapse. What does that mean when it comes to protecting children from polio?
Over the past year, the situation for children in Afghanistan has become even more desperate. Conflict, drought and the pandemic have collided to create an unprecedented humanitarian emergency. The country’s health systems are collapsing under that strain. That’s putting millions of children at high risk of polio and other potentially deadly diseases.
UNICEF remains on the ground in Afghanistan to provide children with the lifesaving immunizations they need, including polio vaccines. Working with the World Health Organization, Rotary International and other partners, we reached 8.5 million children with vaccinations during a campaign in November and December 2021. Over a quarter of those children received their first vaccination in three years. It is worth noting that polio cases in Afghanistan are at an all-time low. But despite the progress, many children are still missing out on their vaccination. As this campaign continues into 2022, even more can be done to reach children.
Immunization teams that travel house-to-house are especially effective – most of all, when run by women. That’s because social norms often restrict male vaccinators from entering homes if adult male family members aren’t there. Women hold the greatest access to households. UNICEF and our partners continue to advocate that the de facto authorities in Afghanistan strengthen the female frontline workforce and house-to-house immunization campaigns.
In addition to strengthening polio vaccine initiatives, there’s a big focus on other critical immunization campaigns such as measles, in an effort to control recent outbreaks that have emerged.
But vaccine campaigns alone are not enough to eradicate diseases like polio. The country needs a stable health system with strong routine immunization and health services to increase vaccine coverage, and permanently stop the spread of the wild polio virus. You can read and learn more about how to build stronger health systems.
Africa was declared free of wild polio in 2020 after Nigeria achieved zero wild polio cases. But some cases of wild polio are now emerging on the continent again. What’s happening?
Late last year, a case of wild polio was detected in a girl in Malawi’s capital, Lilongwe. The virus has affected the nerve cells in her spinal cord, and consequently her ability to walk. It’s the first case of wild polio in Africa in five years, and the first case of wild polio in Malawi in more than three decades.
Months later, in May, a case of wild polio was detected in a child living in northern Mozambique, which borders Malawi. It was also the first time in about 30 years that a case of wild polio emerged in that country.
The cases in Malawi and Mozambique have been tracked back to a polio virus strain from Pakistan. The detection of wild polio outside of Pakistan and Afghanistan underscores the importance for all countries to prioritize polio immunization campaigns and increase surveillance of the virus.
The polio cases in Malawi and Mozambique do not affect Africa’s wild polio virus-free certification currently. That’s because both cases were of an imported strain. But it’s of significant concern as polio can spread fast and can kill or cause permanent paralysis. It spreads most commonly when people drink water that’s contaminated with the faeces of someone who carries the virus. Children under the age of 5, that are living in areas with poor sanitation, are at highest risk.
Malawi’s government has declared a public health emergency and a vaccination drive has been launched in the region. The rapid response is being supported by UNICEF and the campaign is focused on vaccinating more than 20 million children against polio. In addition to covering children in Malawi and Mozambique, doses are also reaching nearby Tanzania and Zambia.
Wild polio isn’t the only concern. There’s a variant, which has been driving cases globally. What is this variant and how concerning is it?
That’s right, there has been a rise in polio variants. It’s important to note that the world has been gaining a lot of ground in the effort to eradicate the wild polio virus. But at the same time, we’re seeing a rise in what’s called circulating vaccine derived polio outbreaks. These are non-wild variants of the polio virus. In the past three years alone, close to 2,000 children have been paralyzed by variants.
These non-wild variants emerge when not enough children are vaccinated against polio in a particular community. In this instance, the oral polio vaccine that is given to children contains a weakened strain of the poliovirus. That helps to develop immunity by building up antibodies. But it can circulate among under-immunized populations if there are poor sanitary conditions and a lack of clean drinking water.
The outbreaks can occur when there are gaps in community-level immunization. Those gaps emerge for a number of reasons. Sometimes immunization campaigns haven’t reached certain children for numerous years. Conflict, insecurity and instability are also reasons why a child might be missing out on their oral polio vaccine. That’s why we’ve seen cases increasing in countries like the Democratic Republic of Congo, Nigeria, Ukraine and Yemen. Vaccine hesitancy and misinformation is also still prevalent in some communities and can be a contributing factor.
In order to prevent these outbreaks of polio variants, it’s imperative that every child is reached with the vaccine.
It seems like we’re in a precarious position and at a pivotal moment. Advances continue to be made to eradicate polio, but clearly there are still real concerns. What’s UNICEF doing to respond?
The vast majority of countries in the world are free of polio. But as long as the polio virus exists, anywhere, no child in the world is safe from this debilitating disease. The virus knows no borders. And the recent emergence of polio outbreaks proves that. The Global Polio Eradication Initiative predicts that if polio isn’t eradicated imminently, we could be looking at a global surge of as many as 200,000 cases every year within the next decade.
As the leading partner of the Global Polio Eradication Initiative, UNICEF is focusing on social and behavior change to address this. We’re working to build trust in the polio vaccine among parents and caregivers. That’s the first critical step towards vaccinating every child. We’re building this trust by working with leaders, local influencers, media outlets and social media platforms in specific communities to provide accurate and timely information about vaccines.
UNICEF is also managing the procurement and distribution of more than one billion doses of polio vaccines every year. That accounts for more than half of the world’s oral polio vaccines. And we don’t stop there. UNICEF is also training health workers to manage the ‘cold chain,’ which ensures that vaccines are kept safe when they’re being transported and stored, before reaching the children that need them.
And when an outbreak is discovered, UNICEF is there to lead a rapid response as part of the Global Polio Eradication Initiative, working in coordination with partners and governments at both a national and local level.