The Fight Against Measles and Polio in Yemen
After two-and-a-half years of war, Yemen is left in ruins and struggling to overcome health, social and economic problems within the country. Demolished hospitals, crippled bridges, bombed industries, and poor sanitation and nutrition contribute to the devastating situation imparted by the war on the country and its citizens.

A Failing Healthcare System in Yemen

The health status of the population in Yemen is currently described as “catastrophic.” Damage from the war has transformed the nation into a fertile environment for cholera due to the highly contaminated water, which amplified the proliferation of fecal bacterial infections.

Since sewage systems have failed and garbage has piled up to cover entire neighborhoods and regions of the country, more Yemenis rely on polluted water sources for drinking and cooking. Alongside cholera, a quarter of all health facilities in Yemen are no longer operating or have already closed down; this situation escalated rates of morbidity and mortality among citizens, particularly those needing surgery or emergency care such as patients with chronic kidney failure who are dependent on life-saving support.

The shortage of qualified health professionals and physicians created a gap in primary healthcare — especially among children — as lower immunization rates led to a significant rise in the number of polio and measles cases reported.

To create a temporary and effective solution, the World Health Organization (WHO) trained more than 50 mobile medical teams and 20 fixed emergency care teams to provide people with increased access to primary health care services, and to support the operation of 72 health facilities as a way to prevent their closure.

The Fight Against Measles and Polio in Yemen

On August 15, 2017, WHO launched the fight against measles and polio in Yemen through its nationwide vaccination campaign. More than 3.9 million children under 5 years go age were vaccinated against polio and around 860,000 children aged 6 months to 15 years were immunized against measles in high-risk areas.

UNICEF also joined efforts toward the fight against measles and polio in Yemen by collaborating with WHO to ensure effective vaccination interventions for vulnerable populations, such as children and pregnant women. Julien Harneis, UNICEF Representative in Yemen, asserted that UNICEF’s mobile teams and staffs sacrifice their lives and endanger their health during their daily outreach activities within the community due to the hazardous conditions present in the country.

The medical and public health professionals work to overcome all obstacles in preventing additional deaths and morbidities associated with preventable diseases such as polio and measles.

Dr. Gamila Hibatulla, Nutrition and Health Officer for UNICEF in Aden-Yemen, explained that mobile teams rely on public sites, such as mosques, to deliver necessary health services. Vaccination is a central goal to both international agencies of WHO & UNICEF so as to prevent and manage any infectious diseases that could create an additional burden for the government and a crumbling healthcare system. Ms. Hibatulla praised the parents of young children for collaborating with the agency’s work by ensuring that their kids get immunized against serious diseases.

Challenges & Setbacks

Despite the national campaign’s accomplishments in the fight against measles and polio in Yemen, Dr. Ahmed Shadoul, the WHO Representative from Yemen, stated that the positive results generated from the campaign were only “the tip of the iceberg” in terms of the international organization’s response. According to Dr. Shadoul, only a portion of the population was reached by these efforts, as a result of limited funding and failure to reach people residing in war zone areas.

Future plans are being developed to render vaccination and primary prevention efforts more effective, and through continuous coordination, cooperation and collaboration between international agencies and the Yemeni community at large, such a goal can be obtained.

– Lea Sacca

Photo: Flickr

important and impactful vaccinationsVaccines are small doses of a disease or virus that prepare the body’s immune system for any future encounters with that disease. After exposure to the disease through vaccination, the body builds up resistance to that specific disease. The development of these important and impactful vaccinations has led to the eradication or near eradication of several diseases that brought death and disability to thousands.

Polio Vaccine

Polio is a disease caused by the poliovirus that can degrade an individual’s spinal cord and musculature. In extreme cases, polio leads to muscle paralysis and death if the paralysis invades muscles used for breathing. In 1952, Jonas Salk developed the first effective polio vaccine. After the development of the vaccine, mass immunization campaigns took place throughout the United States.

Governments then distributed polio vaccines throughout the world. By 1989, polio was eradicated in the Americas, and as of 2017 only Afghanistan, Pakistan and Nigeria had recorded cases of polio. Overall, the polio vaccination campaign is considered one of the most important and impactful global health campaigns in human history.

Smallpox Vaccine

Smallpox is an infectious disease most commonly known by the distinct progressive skin rash it causes that spreads across the body. The disease also gives individuals a fever and severely weakens the body. Approximately three out of 10 individuals that have smallpox die. Smallpox is believed to have dated back to the Egyptian era and caused many deaths throughout global civilization.

A vaccination for smallpox was formally discovered and published in 1798 by Edward Jenner. Throughout the 19th century, smaller scale vaccination campaigns attempted to eliminate the disease’s prevalence. It was not until 1967 that the World Health Organization coordinated a massive vaccination campaign to eradicate the disease globally. In 1977, the last epidemic of smallpox occurred in Somalia.

In 1980, the World Health Assembly officially declared the world rid of the disease thanks to the distribution of these important and impactful vaccinations. Today, the Centers for Disease Control and the World Health Organization describe smallpox eradication as the biggest achievement in public health history.

Yellow Fever Vaccine

Yellow fever is a mosquito-borne disease that affects countries in equatorial climates. Yellow fever causes serious bleeding of the internal organs and in many cases results in death. The illness derives its name from the jaundice symptoms, or yellow discoloration of the skin, that usually result from infection. In 1937, while conducting research at the Rockefeller Foundation in Ecuador, microbiologist Max Theiler developed an effective vaccination strain.

Later, the global health community distributed the vaccine to the countries most affected by the illness. In 1952, Theiler received a Nobel Prize for his efforts in disease eradication. Today, yellow fever outbreaks are common, but these important and impactful vaccinations continue to save millions of lives.

Furthermore, countries with disease prevalence are taking massive steps to eliminate yellow fever. For instance, as of January 2018, the Nigerian government has set a goal to vaccinate 25 million individuals in hopes of meeting a global effort to end all yellow fever epidemics by 2026.

Vaccinations are one way that foreign aid and global health work hand in hand to genuinely help humanity. While there are more diseases that need to be researched and certainly more vaccinations to distribute, it is important to take stock of historical public health achievements and incorporate their successes into future efforts.

– Daniel Levy

Photo: Wikimedia Commons

the effort to eradicate polio2018 marks the 30-year anniversary of the first international effort to eradicate polio. Polio has been one of the most-feared illnesses throughout history and has recurred in epidemics since the beginning of recorded medicinal history. Over time, the effort to eradicate polio has become exponentially more effective, with a total of only 14 confirmed cases in 2017. But that effort did not begin until 1988, and the vaccine for the virus was created only 30 years earlier in 1954.

Polio epidemics became extremely visible when President Franklin Roosevelt contracted the virus in 1921, while he was still working as the vice president of a bonding company. He created the Warm Springs Foundation, a polio rehabilitation center, in 1927 and spurred further efforts for rehabilitation.

Now iconic and obsolete, the iron lung was the next major rehabilitation tool created in 1929. Because polio causes muscle paralysis, many sufferers of the virus became unable to breathe due to respiratory paralysis. The iron lung provided breathing assistance to those whose illness had progressed far enough to need it.

However, it was not until after Roosevelt died in 1945 that a polio research project was founded. Dr. Jonas Salk was the head of the research project in 1947, which yielded the very first successful polio vaccine six years later in 1953.

After two years of field trials, the vaccine was declared a success. Between 1955 and 1957 alone, the incidence rate of polio dropped by 85 percent. It continued to drop further once Salk’s vaccine was replaced by a more cost-effective and easily-distributed vaccine.

In 1985, the Rotary Fund initiated the PolioPlus program, a movement to immunize all children worldwide against polio. Three years later, in 1988, the WHO, CDC, UNICEF and Pan American Health Organization banded together with the Rotary Fund to launch an international immunization campaign and the official effort to eradicate polio.

When the immunization campaign was launched in 1988, there was an estimated total of 350,000 cases of polio. By 1994, the Americas were declared polio-free, and by the year 2000 the incidence rate of polio was down 99 percent, and the western Pacific was also declared polio-free.

As of 2017, only three countries in the world continue to experience endemic polio infections: Afghanistan, Pakistan and Nigeria. Children under the age of five have the highest risk of contracting the illness because many are too young to receive the full course of vaccinations. According to the WHO, “as long as a single child remains infected with poliovirus, children in all countries are at risk of contracting the disease.” Because these three countries have lower rates of immunization throughout their populations, they are at higher risk of spreading the disease and letting it cross their borders

The Rotary Foundation’s effort to eradicate polio has become 99 percent effective, but the remaining 1 percent poses a risk to the entire world. Through education, mobilization and donation, the effort to eradicate polio becomes stronger every day.

– Anna Sheps

Photo: Flickr

Polio EradicationAround 30 years ago, 350,000 people annually were disabled by polio. Since then, the disease has been reduced globally by 99.9 percent. Only eight new cases were reported this year. Afghanistan, Nigeria and Pakistan are the three remaining countries where polio exists. Nonetheless, governments and non-profits continue to work toward polio eradication, with some experts believing the disease could be eradicated as soon as 2020.

In June 2017, at Rotary International’s annual convention, the Bill & Melinda Gates Foundation and Rotary International jointly announced their pledge of $450 million toward polio eradication. At the same time, world governments and other donors pledged a total of $1.2 billion to the Global Polio Eradication Initiative (GPEI).

GPEI is a collaborative effort among Rotary International, Bill & Melinda Gates Foundation, U.S. Centers for Disease Control and Prevention, the World Health Organization and UNICEF to combat polio.

The good news continued in August of this year when the United Kingdom announced that they would be pledging £100 million to the fight against polio. This funding will provide immunizations to 45 million children per year until 2020.

Though prior to this summer there was a funding gap of $1.5 billion for polio eradication, that shortfall has now been reduced to $170 million due to the contributions of Rotary International, the Bill & Melinda Gates Foundation and the United Kingdom as well as others.

While the focus now is on the three countries where polio still exists, the GPEI and its partner organizations still monitor polio in other at-risk countries.

Although the United Nations declared Somalia polio free, President Farmaajo stated that vaccination campaigns remain crucial. He noted that Somalia is still vulnerable and that polio eradication in Somalia “…was [a] collective effort and commitment by many young men and women who sacrificed their lives.”

The infrastructure built to combat polio in Somalia continues to be used to respond to other outbreaks including measles and cholera. Polio also tends to infect regions marred in conflict. In 2013, there were polio outbreaks in Central Africa, the Horn of Africa and the Middle East. The GPEI managed to end the outbreaks less than a year later.

Nigeria, one of the three countries on the endemic list, was taken off the list at one point after two years with no reported cases. Soon after, four children were paralyzed by polio in northern Nigeria. In response, the GPEI strengthened its polio surveillance operations.

It takes three years with no reported cases of a disease for it to be declared eradicated. Smallpox is the only eradicated disease in history. The United Kingdom International Development Secretary, Priti Patel, stated that, “The world is closer than it has ever been to eradicating polio, but as long as just one case exists in the world, children everywhere are still at risk.”

Due to the contributions of multiple governmental and non-governmental organizations, polio eradication is an achievable goal for the international community.

Sean Newhouse

Photo: Flickr

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