Despite decades of vaccine development, smallpox remains the only disease ever
to be fully eradicated by vaccination. By the end of 2026, the Global Polio
Eradication Initiative (GPEI) hopes that polio will be added to that short
list.
اضافة اعلان
Poliomyelitis, more commonly known as polio, is a
highly infectious virus that can cause paralysis or death in those infected.
Clinically identified in 1789, there is no cure for polio, and the only hope
for containment lies in vaccination.
Since the launch of GPEI, in 1988, global polio
cases have fallen by around 99 percent, and two of the three wild virus
varieties have been eradicated. Southeast Asia and Africa have been declared
polio-virus free, and there are now just two countries where the virus remains
endemic: Afghanistan and Pakistan.
Cases in both countries have risen since 2014,
compounded by conflict and security problems, natural disasters, and COVID-19,
all of which have undermined efforts to vaccinate communities.
In Afghanistan, there were 56 officially reported
cases in 2020 (and likely many more that went unreported), up from 29 the
previous year. In 2020, Pakistan saw 84 cases of polio, and 20 cases have been
detected this year already, mostly in the virus hotspot of Khyber Pakhtunkhwa.
Failure to control and eradicate endemic polio in
these two countries poses a health threat far beyond their borders.
Three challenges must be overcome if polio is to
follow smallpox into extinction. First, at the global level, donors need to
increase their financial commitment to the GPEI. Second, national — and
especially sub-national — government institutions must better coordinate and
prioritize efforts to reach all communities. The final, and biggest challenge,
is to reduce community mistrust and vaccine hesitancy in places like
Afghanistan and Pakistan.
At the World Health Summit in Berlin last month,
donors pledged $2.6 billion — which included $1.2 billion from the Bill and
Melinda Gates Foundation — to fund the GPEI’s five-year polio-eradication
strategy. However, this leaves a significant shortfall of almost $1.9 billion.
In the current climate of global and financial
instability, donors may be unwilling to step up. There has been considerable
criticism of the UK, for example, for cutting its funding for polio eradication
by 95 percent last year.
This makes the role of regional donors more
important. The UAE, for instance, has been a long-standing supporter of
eradication efforts, especially in Pakistan; the UAE has given that country
more than $200 million since 2014 to pay for 600 million doses of vaccine,
protection for more than 100 million children. Amid the international
shortfall, Middle Eastern donors may find themselves under increased pressure
to provide more funding.
The next four years are an opportunity to eradicate polio once and for all. But doing so will require coordination to ensure the global, national, and local level challenges are addressed.
International financing is important, but commitment
and support at national and district levels is also critical to successful
polio campaigns. Governments need to ensure both adequate infrastructure and
safe access for health workers. District level governments, though, often
suffer a dearth of resources and find it difficult to juggle multiple and sometimes
competing priorities.
In Pakistan, recent floods have diverted attention
and spending from other programs, but the disasters also presented
opportunities: As part of the humanitarian responses, emergency health
facilities have been used to provide routine immunizations, including for
polio, to affected children.
Eradication efforts in Afghanistan are even more
fraught. Before 2021, several Taliban-controlled district administrations
banned local polio campaigns. Since taking control of the central government in
August last year, the Taliban have restarted the national program. But remote
regions have less infrastructure, are hard to reach and are often governed by
local officials who may provide less support. An estimated 700,000 Afghan
children cannot be reached by immunization teams.
The biggest challenge is overcoming vaccine
hesitancy in communities deeply suspicious of health campaigns. Parents can
refuse to allow their children to be vaccinated, and health workers can face
threats of violence. Not only does this leave these communities at significant
risk, it also creates pockets of virus reservoirs from which a wider regional
and even global resurgence could occur.
To eradicate polio, vaccination coverage must be
high. The most common vaccine uses a weakened, but still live form of the
virus. In well-vaccinated communities, this weakened virus — which is excreted
and can therefore be transmitted — is innocuous. But in places where large
parts of a community remain unvaccinated, the vaccine can mutate into strains
that can create symptomatic polio, including paralysis.
This form — known as circulating vaccine-derived
polioviruses (cVDPV) — has been growing globally over the last decade, with
recent outbreaks in parts of Africa that have eradicated wild polio virus.
Greater efforts at engaging and working with communities are essential if
vaccination is to be successful, and if wild and cVDPV forms of the virus are
to be wiped out.
Vaccine hesitancy is not just about mistrust and
ignorance. In February, eight polio workers were murdered in northern
Afghanistan. This shows how local, national, and even international politics
and tensions can create mistrust and suspicion around vaccination campaigns,
undermining efforts to control the virus.
After the US reportedly used a fake vaccination
campaign as part of its efforts to capture Al Qaeda leader Osama bin Laden in
Pakistan in 2011, anti-vaccine campaigns and attacks on vaccinators increased,
leading to a marked decrease in vaccination rates in parts of the country.
The next four years are an opportunity to eradicate
polio once and for all. But doing so will require coordination to ensure the
global, national, and local level challenges are addressed. Failure to ensure
full funding, to improve coordination, and to win the trust of communities will
be an opportunity wasted, the consequences of which would be devastating.
Michael Jennings is a
professor in global development at SOAS University of London, where he works on
issues related to global health and the politics and history of global
development. Syndication Bureau.
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