Polio in PakistanAs one of only three countries that is still threatened by the poliovirus, Pakistan is continuing to fight against this devastating disease. Despite its threat, however, Pakistan has made incredible progress in eradicating polio for good. Leading the fight to end polio in Pakistan is the World Health Organization (WHO), which has initiated many effective vaccination campaigns.

Individuals in Pakistan are at a high risk for contracting polio during what is called the “high season” – the period between June and September, where temperatures are high and the polio virus is active. The initiatives to end polio focus on prevention during the “low season,” when polio is practically inactive. This strategic planning is meant to prepare the people and work ahead of the virus.

During low season in 2016 and 2017, five nationwide vaccination campaigns were run by the WHO, with 250,000 trained polio workers going door-to-door to vaccinate children. By the end of May 2017, over 38 million children under the age of five had been vaccinated against polio.

The vaccination workers were able to target the high-risk populations by taking innovative approaches, such as employing community-based vaccination – this made it easier to reach tribal populaces. These workers also used mobile strategies in order to reach high-risk nomadic populations.

While the WHO has vaccinated 92 percent of targeted children, it has yet to reach the desired goal of 95 percent, which is the figure needed to consider polio eradicated. However, much progress has been made in the past nine months, with two high-risk regions making drastic inclines in vaccination numbers. The Khyber Pakhtunkhwa region increased from an 84 percent vaccination rate to a 95 percent vaccination rate; Sindh went from a mere 77 percent to 93 percent.

Recorded cases of polio in Pakistan have reached a new low, dropping from 306 in 2014 to 20 in 2016. So far in 2017, there have only been three cases of polio. It is possible that by the end of this year, polio could be considered eradicated in Pakistan thanks to the significant progress and efforts by the WHO. While a small percentage of the population must still be reached in order to completely get rid of polio in Pakistan, the vaccination efforts have been nothing short of extraordinary.

Kelly Hayes

Photo: Flickr

The Gates Foundation, alongside government organizations from around the globe, is working hard to eliminate the polio virus. Rob Nabors, Director of the Gates Foundation, who oversees policy, advocacy, government relations and communications says he doesn’t think the general public realizes that, in the next two years, polio could be completely eradicated on a global scale.

The poliovirus is passed through contaminated feces and is spread as a result of poor hygiene and sanitation. It is responsible for millions of people becoming paralyzed before vaccines became widely available in the 1950s.

Since the launch of global eradication efforts in 1988, polio incidences across the globe have dropped more than 99 percent. The disease’s occurrence rate plunged to 233 recorded cases in 2012 and occurred in only three countries: Nigeria, Afghanistan and Pakistan. India, which was once considered to have the greatest challenge of eliminating polio, was declared free of the disease in February 2012.

According to the Centers for Disease Control and Prevention, four of the six regions of the World Health Organization have been certified polio-free. This includes the Americas in 1994, the Western Pacific in 2000, Europe in 2002 and Southeast Asia in 2014. This constitutes 80 percent of the world’s population currently living in polio-free areas.

Nabors and the rest of the Gates Foundation work hard to educate nations around the globe on the impact of their help. The organization believes it is up to those educated on polio to explain to audiences in the developed world exactly how important the leadership of polio-free countries actually is.

Unfortunately, budget cuts could have a significant impact on the complete eradication of the disease. Proposed cuts in the United States would shrink the budget from $30 billion in 2017 to $20.7 billion in 2018. These proposed budget cuts would make it difficult for organizations such as the Gates Foundation to interact with federal programs. The result would be that areas in need of polio vaccinations and education would not receive nearly as much help.

If polio were to be eliminated, it would become the second disease, the first being smallpox, to be eradicated globally. Proper funds for the delivery of polio vaccinations to areas in need is crucial for the disease’s eradication.

Drew Hazzard

Photo: Flickr

The Good News: Polio Eradication by 2020
With the support of public and private institutions such as WHO, Rotary International, the U.S. Center for Disease Control and Prevention (CDC), UNICEF and the Bill and Melinda Gates Foundation, polio case numbers have decreased by 99 percent since 1988.

Moreover, 80 percent of the world’s population is now living in certified polio-free regions. There are just three countries that have been unable to stop the spread within their communities: Afghanistan, Nigeria and Pakistan.

In these countries, progress had been slowed due to weak health infrastructures as well as ongoing political conflicts and security concerns.

Just last year as Nigeria had been declared free of polio, new cases appeared in Borno state. This area had been inaccessible due to the control of the militant group Boko Haram; thus, medical professionals were unable to provide the vaccinations and preventative measures needed to stop the virus from circulating.

Despite these setbacks, complete and successful polio eradication in all countries is still expected by 2020. According to Bill Gates, fulfilling this timeline would require the last case of polio to be recorded in 2017, where a three-year period will ensure that the virus has completely disappeared.

Polio, which has not been a huge health crisis in the majority of countries, has existed in low-income countries where it has affected mainly children under the age of five. One in 200 infections lead to irreversible paralysis. However, preventative measures are easy.

Although there are two forms of the vaccine, oral polio vaccine (OPV) and inactivated polio vaccine (IPV), just one dose of OPV costs as little as 14 cents.

Last week, with the help of Gates, billionaire philanthropists such as former New York City Mayor Michael Bloomberg and Ray Dalio, chairman and co-chief investment officer of Bridgewater Associates LP, collectively donated more than $70 million toward the Global Polio Eradication Initiative. These costs have brought the efforts a step closer to the $7 billion required to fund these low-cost vaccines and overall eradication efforts.

Dalio, through a representative, said, “Just from an investment perspective, eradication makes sense. It will eliminate the future financial burden, and unlock doors to economic productivity around the world.”

With a proven track record of eliminating polio in various countries and with the additions of donated funds to this global initiative for polio eradication, WHO and participating institutions can achieve the goal of polio eradication by 2020.

In 1988 polio-affected 125 countries and paralyzed 350,000 people every year, but there are now less than 100 cases — soon this number will reach zero.

Priscilla Son

Photo: Flickr

Disease Prevention: Polio in Africa is Nearly Eradicated
After a 28-year-long effort, polio in Africa is nearly eradicated. In August, the World Health Organization launched an intensive investigation into all of the continent’s collected data. The results already indicate one of the greatest public health victories of the century.

Only two cases of polio, both of which occurred in Nigeria, have been reported in the last two years. While these couple of cases prove that more work is needed, the global health community has made incredible strides in eradicating polio in Africa and throughout the rest of the world.

Polio is a highly infectious virus that progressively destroys the central nervous system. Initial symptoms include fatigue, headache, fever, vomiting, pain in limbs and stiffness of the neck. In some cases, it only takes several hours to cause total paralysis of the entire body. The virus spreads person to person or by way of a contaminated vehicle, contaminated drinking water or food are a couple of examples. Children are most susceptible and have been the focus of large-scale vaccination efforts for decades.

When the Global Polio Eradication Initiative launched in 1988, the disease was present in over 125 countries. More than 350,000 people were paralyzed every year. Since then, cases have dropped by 99% and universal vaccination has protected over 13 million children from potential paralysis.

Today, polio was eradicated throughout most of the world. According to the CDC, the U.S. hasn’t seen a single case since 1979. For countries whose health care delivery systems lack funding, infrastructure and political support, polio eradication is an astonishing victory.

Pakistan and Afghanistan are the only two countries where polio transmission has never been interrupted. Even so, the two nations have joined forces to improve vaccination efforts. Pakistani and Afghan leaders have pinpointed their shared border as the focal point of their synchronized effort, establishing 14 new vaccination points.

Recognizing this victory in context reminds us that long-term disease control is possible given the cooperation of stakeholders at the local, regional, national and international levels.

Jessica Levitan

Photo: Flickr

Polio-Free Nigeria July 24, 2016, marks Nigeria’s two-year anniversary without any new polio cases. This is a significant step toward certification for polio-free Nigeria in 2017.

Known to mainly affect young children, poliomyelitis (polio) is spread through fecal-oral transmission and by consuming contaminated food or water. The virus multiplies in the intestine, and can invade the nervous system and cause paralysis.

On September 25, 2015, the World Health Organization (WHO) removed Nigeria from the polio-endemic list. The disease only remains endemic in Pakistan and Afghanistan.

This is the longest Nigeria has gone without signs of the poliovirus and is certainly an important milestone.  However, President Muhammadu Buhari highlights that “we have not recorded any case of polio in the last two years, but we should not be complacent.”

In order to declare Nigeria completely polio-free, authorities are now focusing on  vaccinations – and making sure everyone gets them. According to WHO, failure to treat just one person could lead to additional run-ins with the virus, up to 200,000 new cases each year, all around the world.

In 2012, Nigeria accounted for more than half of all polio cases worldwide. However, with the combined efforts of the government, leaders and thousands of health workers, that statistic has greatly diminished and Nigeria is moving toward a polio-free state. Volunteers have immunized more than 45 million children under the age of five.

The establishment and funding of health programs have also had a serious hand in Nigeria’s success. The Hard-to-Reach project has gone the extra mile, operating in high-risk states in Nigeria. While polio is the main focus of these camps, other services such as prenatal care, routine vaccines, basic medicines, screening for malnutrition and health education are also offered.

If the country continues to follow through with the necessary medical procedures and protect new individuals from contracting the virus, a polio-free Nigeria could be a reality in the very near future.

Mikaela Frigillana

Photo: Flickr

Polio in Pakistan and Afghanistan
For the past century, scientists and organizations across the world have diligently fought to eliminate the poliovirus from humanity once and for all. Although this goal is incredibly close to fruition, the presence of polio in Pakistan and Afghanistan holds up the complete eradication of the pervasive disease.

Polio Occurrences and its Slow Eradication

The Australian Broadcasting Corporation, or ABC, reported that the first polio epidemic occurred in 1916 on the east coast of the United States. Gareth Williams, emeritus professor at the University of Bristol and author of the book Paralyzed with Fear: The Story of Polio, wrote that “about 25,000 people were paralyzed in and around New York, and 6,000 of those died.”

The Centers for Disease Control and Prevention (CDC) states that the poliovirus lives in the throat and intestines of the infected person, and that it can only be caught through oral contact with disease-ridden feces. Unlike other diseases, only humans can spread polio, which makes eradication a little easier to achieve.

Thanks to Jonas Salk and Albert Sabin’s invention of extremely effective vaccines, most of the industrialized world was free from the threat of polio by 1960. Unfortunately, their admirable mission still needs to be completed — there is still polio to eradicate. Due to this need, the Global Polio Eradication Initiative (GPEI) formed in 1988 when the World Health Organization (WHO), joined by Rotary International, CDC, UNICEF and the Bill and Melinda Gates Foundation, made ending polio an urgent mission.

Since its formation, the ABC reports that this team of organizations has been able to cut rates of polio “from 350,000 per year to less than two-dozen cases so far in 2016.” Today, Pakistan and Afghanistan are the only two countries where polio has not been eliminated; but this is sure to change.

The Ongoing Battle

The continued prevalence of polio in  Pakistan and Afghanistan is a result of multiple factors. The ABC stated that most of the polio cases in Afghanistan this year have occurred in a small part of the Shigal district, which is staunchly anti-government and does not allow vaccinators to enter.

In Pakistan, the Taliban attack health workers and immunization centers, believing that vaccinations are used by the U.S. and other countries to sterilize and spy on Muslims. Also, the border between the two countries is easy to traverse and allows for the disease to travel easily from one region to the next.

According to their website, the Bill and Melinda Gates Foundation “contributes technical and financial resources to accelerate targeted vaccination campaigns, community mobilization, and routine immunization.”

The foundation is working alongside local scholars and religious leaders to achieve multiple goals: convince families to vaccinate their children, create updated maps and programming to help workers locate children that need vaccines, develop new vaccines and work with other GPEI organizations to improve fundraising for the elimination of polio in Pakistan and Afghanistan.

The eradication of polio in Pakistan and Afghanistan is near. In a recent article, The National wrote, “by the end of this year, or early next at the latest, Afghanistan and Pakistan will declare themselves free of poliomyelitis.” Such an accomplishment will be one step for Afghan and Pakistani health, and one giant leap for the health of humankind.

Liam Travers

Photo: Flickr

polio vaccineIn a coordinated effort of unprecedented size in vaccine withdrawal, 155 countries switched polio vaccines. The switch to the newer form of the polio vaccine occurred between April 17 and May 1 and could help stop the trend of polio-based paralysis in hundreds of thousands of children.

Monitors from the World Health Organization are following up in various countries to confirm that stocks of the old vaccine have been properly disposed of. The switch was the second phase of the WHO’s Polio Eradication and Endgame Strategic Plan 2013–2018.

Eventually, the WHO’s plan anticipates a complete withdrawal from oral polio vaccines in 2019 or 2020.  In addition, it foresees a complete reliance on inactivated vaccines, which contain dead forms of the virus.

Health care providers use oral vaccines because they are cheap and easy to administer. These vaccines work by containing a weakened, but still live, form of poliovirus and exit in the stool shortly after vaccination. In areas with very inadequate sanitation, the viruses have an extremely small chance of spreading between children and redeveloping the ability to cause paralysis.

The switch is from a trivalent form of the polio vaccine that protected against three strains of the virus. The newer, bivalent form no longer contains the type 2 strain, which has been declared eradicated in its “wild” form with no new cases since 1999. Because the Type 2 vaccine viruses can reduce immunity to the other strains and increase the chance of redeveloping paralysis, removal of the type 2 component was the next step in the long-term polio eradication plan.

The global polio eradication has found success in all but two countries, Pakistan and Afghanistan, since it began in 1988. The U.S., which discontinued use of the oral vaccine since 1999, relies on the injectable polio vaccine and was not involved in the recent switch.

The slight possibility of a Type 2 poliovirus outbreak exists because of the switch. Therefore, a stockpile of monovalent oral polio vaccine containing only the type 2 virus will be kept. Synchronizing the switch across the globe was thus crucial in minimizing the risk of the Type 2 poliovirus reemergence.

Polio is at its lowest rates in history. Leaders of the eradication program foresee that if no additional cases occur in the next three years, polio could be declared fully eradicated by 2019. However, countries should continue vaccination for at least five years afterward. If success continues, polio will be only the second disease after smallpox to be eradicated by vaccines.

Esmie Tseng

How to Stop Polio
In the process of discerning how to stop polio permanently, health professionals must focus on the developing world.

Poliomylelitis, commonly known as polio, is a disease that spreads through contaminated water or food supplies. It can cause paralysis and in rare cases, even be lethal.

Most infected people (90 percent) have no visible symptoms of being infected with polio. However, some initial symptoms of the disease may include fever, fatigue, headache, and vomiting. These are quite similar to the symptoms of the common influenza virus.

However, as polio progresses, stiffness in the neck and pain in the limbs will occur.

The stiffness and pain then progresses into irreversible paralysis, usually in the legs of the infected person. So how does one stop an “invisible” disease? How to stop polio throughout the world?

The Polio Eradication and Strategic Endgame Plan 2013-2018 endeavors to build a polio-free world by 2018 through a four-step plan:

1. “Detect and interrupt all poliovirus transmission;

2. Strengthen immunization systems and withdraw oral polio vaccine;

3. Contain poliovirus and certify interruption of transmission;

4. Plan polio’s legacy.”

The first two steps are the most important when discerning how to stop polio. Detection of poliovirus is difficult, because there are two strains which have the ability to paralyze: wild poliovirus and circulating vaccine-derived poliovirus (cVDPV).

According to the WHO, polio has no known cure once a person is infected. However, there is an oral polio vaccine available.

An oral vaccine works by containing a weakened form of the virus (in this case poliomylelitis). This virus then enters the child’s bloodstream and activates an immune response.

The vaccine-virus then replicates in the child’s intestine for a limited period, building up crucial antibodies necessary for fighting off a future polio infection. The child then excretes this vaccine.

This excreted vaccine-virus will continue to survive and becomes a circulating vaccine-derived poliovirus (cVDPV). In developing countries with poor sanitation, cVDPV will infect people who haven’t received the vaccine yet.

Consequently, the oral vaccine can spread the disease just as often as it prevents it.

By contrast, the injectable poliovirus vaccine (IPV) does not have an active form of the poliovirus. Therefore, it cannot infect another individuals.

Switching from an oral poliovirus vaccine (OPV) to an injectable poliovirus vaccine (IPV) eliminates the potential of cVDPV occurring in a population.

The strain of poliovirus utilized in IPV shots is inactivated. When recipients excrete it, there is no chance of contracting polio from the excrement.

OPVs are often used in developing countries with large rural populations lacking in access to medical facilities. This is because oral polio vaccines do not require the sterile needles for injections.

The Polio Global Eradication Initiative seeks to make a smoother transition from the oral vaccine to an injected one by creating a multi-step process. Instead of immediately removing OPVs from circulation, they plan to first use a different OPV and supplement it with an IPV.

This transition must occur globally in order to be successful. A bivalent OPV will decrease the chance of cVDPV. Eventually, all countries will be able to switch to using IPV shots.

How to stop polio? Ensuring that all countries have access to proper medical care and sanitation services is a start. It is also important to continue to spread awareness of the importance of vaccinating children against polio.

Bayley McComb

Photo: USAID

Why Thailand's Measures Against POlio are Intensified
In 2014, the World Health Organisation (WHO) declared that “the spread of polio is an international public health emergency.”

The poliovirus is transmitted through contaminated food and water and it multiplies in the intestine. It can also invade the nervous system and cause spinal and respiratory paralysis in one in every 200 infections. The disease is capable of causing death within hours.

On Feb. 18, Thailand stepped up its precautionary measures against polio, when Laos, a neighboring country, declared a public health emergency as a result of the virus.

The director-general of the Department of Disease Control (DDC) stated that “though Thailand is declared free of polio, Thais are still at risk of contracting the disease particularly in provinces close to Laos.”

In these border areas, residents are required to receive polio vaccines. Acute flaccid paralysis patients and patients from Laos in border hospitals are advised to be kept under close surveillance. According to the DDC, authorities in Laos have also rolled out two measures against polio, including residents in Laos being required to receive polio vaccines one month before leaving the country and having the vaccine administered to people planning to stay in Laos for more than one month.

The main concern for the intensified measures against polio is the spread of vaccine-derived polioviruses (VDPVs) in Laos and Myanmar recently.

According to authorities, the VDPVs are “strains of the poliovirus that have genetically mutated from the strain contained in the oral polio vaccine.”

In April, Thailand and other countries are expected to simultaneously switch from using the trivalent oral polio vaccine, “which contains three poliovirus serotypes, to bivalent OPV in an effort to eradicate wild poliovirus type 2.”

Here, unlike the previous vaccine, when digested by the body, this one replicates in the intestinal tract, providing immunity from subsequent polio infections.

Polio has caused many disabilities and deaths around the world. Thailand is making great efforts to minimize the spread of this disease locally and subsequently helping save the lives of others from this deadly disease.

Vanessa Awanyo

Sources: BBC, Bangkok Post
Photo: Flickr

Polio_EradicationToday, the Global Polio Eradication Initiative in collaboration with the World Health Organization (WHO), in the largest public-private partnership in healthcare, has reduced polio by 99 percent.

The two organizations first came together in 1988, a time when wild poliovirus was endemic in 125 countries and about 350,000 people, primarily young children, were paralyzed by polio annually. Since then, it is estimated that 10 million children globally have been saved from paralysis.

According to global polio surveillance data from November 4, 2015, 51 cases of wild poliovirus have been reported this year. Thirty-eight of those cases occurred in Pakistan and the remaining 13 cases appeared in Afghanistan.

The Initiative’s goal is to ensure a polio-free world for future generations by distributing a polio vaccine to every child.

According to NPR, the oral polio vaccine may go down in history as one of the most powerful public health tools of modern times. The vaccine is cheap, easy to administer and has pushed polio to the brink of extinction.

But, there is a downside to this version of the vaccine. Unlike its predecessor, a vaccine which is administered by injection, the oral version contains live polio virus. Under some circumstances, the virus from the vaccine can spread, mutate and cause the same paralysis it intended to prevent.

This occurs when a child who’s been vaccinated sheds live virus in their stool. Like wild poliovirus, these vaccine-derived strains thrive in places where there’s poor hygiene, particularly when drinking water is contaminated with human sewage.

The number of vaccine-derived polio cases relative to the hundreds of millions of doses of oral polio vaccine administered each year is incredibly low. According to the Initiative, to date this year, only 16 cases of vaccine-derived polio have been reported globally.

But, that’s almost 11 percent of all cases of polio globally.

Last month, the WHO announced the beginning of a program to phase out oral polio and switch to a safer oral vaccine by April 2016 that contains no live virus.

“The idea of the polio eradication is…to eradicate viruses whether they’re in vaccines or in the environment,” says Elias Durry, emergency advisor on polio for the WHO’s Eastern Mediterranean region. “To get rid of the virus we have to also remove the vaccine that contains the virus.”

Eventually, the rest of the oral polio vaccine used around the globe will be withdrawn from circulation and the final vials destroyed.

It is imperative that we make this final push towards eradication a top priority.

Dr. Thomas R. Frieden, director at the Center for Disease Control, explains, “If we fail to get over the finish line, we will need to continue expensive control measures for the indefinite future . . . More importantly, without eradication, a resurgence of polio could paralyze more than 200,000 thousand children worldwide every year within a decade.”

Kara Buckley

Sources: CDC, Gates Foundation, NPR, Global Polio Eradication Initiative, WHO
Photo: Flickr