Maryn McKenna

Journalist and Author

A New Polio Case in Pakistan and an Unsolved Epidemic

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A Pakistani health worker administers polio drops to a child during a polio vaccination campaign in Karachi on January 20, 2015.

A Pakistani health worker administers polio drops to a child during a polio vaccination campaign in Karachi on January 20, 2015. Rizwan Tabassum/AFP/Getty Images

Time to check in on another globe-spanning epidemic. While we were all watching Ebola, polio continues—and as long as it does, it holds the possibility of surging back over the rest of the world.

A quick refresher: Polio has been the target of a very expensive and aggressive multi-national eradication campaign since 1988. By last summer, polio was endemic—that is, transmission from one person to another has never been interrupted—in Afghanistan, Pakistan and Nigeria. Very high rates of vaccination have kept the paralyzing disease from leaking over those countries’ borders to most of the rest of the world—but every once in a while, something slips through, or a country runs out of money and lets its vaccination campaigns lapse.

As a result, last year, there was still polio in seven other countries — Cameroon, Equatorial Guinea, Ethiopia, Iraq, Israel, Somalia and Syria—and the World Health Organization declared an international emergency.

So, updates: Despite its ongoing civil strife, Syria has not had a polio case in a year. There has been no detection of polio virus in sewage in Israel or the West Bank or Gaza since March. It has been almost 6 months since the last polio case in Nigeria—extremely good news because that country has periodically re-infected other areas of Africa.

But: Pakistan remains a problem.

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CIA: In Future, We Won't Derail Major International Public Health Efforts. (Thanks?)

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Image: Julian Harneis (CC), Flickr

There’s news out this week that feels almost impossible to deliver without an eyeroll: The CIA has promised that it will “never again” use an international vaccination campaign as a cover for intelligence gathering.

I can’t see why not. I mean, the last attempt ended so well.

(Yes, that was sarcasm.)

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Polio Declared An International Health Emergency

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Prefvotuporanga (CC), Flickr

Image: André Luiz D. Takahashi (CC), Flickr

In a move that is simultaneously discouraging, urgent and deeply unusual, the World Health Organization has declared that the resurgence of polio is a “public health emergency of international concern.” It’s an extraordinary statement, coming less than four months after India — once considered a place where polio might never be vanquished — was declared polio-free after three years without a new case.

That achievement left only Afghanistan, Nigeria and Pakistan as countries where the chain of polio transmission had never been broken. But as the virus persists in those countries, it is also moving out across their borders. Seven other nations that previously had beaten polio — Cameroon, Equatorial Guinea, Ethiopia, Iraq, Israel, Somalia and Syria — have now been reinfected, and the virus is spreading in communities there.

If the continued existence of polio is news to you, you’re not alone. It’s a largely forgotten disease in the industrialized West; the last United States case occurred in 1979. The WHO, the Centers for Disease Control and Prevention, the fraternal organization Rotary International and a raft of partners have been pressing an international and very expensive eradication campaign since 1988. Every time the world has gotten close, though, polio has flared up again. The WHO once thought it would be able to declare the disease eradicated in 2000; then it set 2005 as a target; then 2008; 2012; 2015; and now, a hoped-for 2018. (Here’s my archive of posts.)

But the past couple of months have thrown even that into doubt. The trigger for the WHO’s action was the discovery that there have been 74 cases of polio so far this year. That seems like a low number, but there were only 417 in all of 2013. And, crucially, winter is considered polio’s “low season” — so for polio to be spreading now rings an alarm bell for the warmer, wetter months when it usually spreads faster and further.

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Polio Eradication: The Bad News Continues

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When last we left the long asymptote of polio eradication, nine health workers in Pakistan who had been administering polio vaccine had been murdered, presumably by the Taliban or its sympathizers, because polio eradication has been cast by them as a plot against Islam in the wake of a CIA operation which used vaccinations as an attempt to get close to Osama bin Laden.

(If this story is new to you: Yes, really. For background, start with this post, and then read this, this, and this.)

So it’s discouraging to say that, in the past few weeks, the news hasn’t gotten any better — though some additional voices have joined the debate in an attempt to stress to the world how important this moment is.

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Taliban Murders Six Immunizers in Wake of CIA Polio Ruse

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(This post has been updated. Read to the end.)

There is news today, confirmed by several media outlets and also by the World Health Organization and UNICEF, that six people working as polio vaccinators were murdered in three separate coordinated attacks in Pakistan. While no one has yet claimed responsibility, it is widely assumed that the attackers have ties to the Taliban, which has opposed the polio-vaccination campaign as a Western plot and accused vaccinators of working as spies for the CIA.

This is grievous and appalling. Infuriatingly, it was also predictable. Constant readers will remember that, back in 2011, the CIA did use a vaccination campaign as a ruse to attempt to to find Osama bin Laden. The unsuccessful attempt was denounced all over the world for putting the polio campaign at risk, and news sources within Pakistan quickly began reporting that vaccinators were feeling threatened. Adding to the sense of threat, a Taliban commander blocked the campaign in one province last June, a United Nations doctor and his driver were fired on in July, and a vaccinator was executed in October by a man who roared up on a motorbike and dashed away.

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Update: Pakistan, Polio, Fake Vaccines And The CIA

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Regular readers will remember my outraged rant post from almost a year ago, reacting to the news that the Central Intelligence Agency faked a vaccination campaign in Pakistan as a way of getting close to Osama Bin Laden’s hide-out, hoping to prove his presence by using a vaccine needle to grab a sample of DNA.

I felt, and still feel, that the maneuver — which was belatedly acknowledged by the CIA — was a cynical attempt to hijack the credibility that public health workers have built up over decades with local populations. I especially felt it endangered the status of the fraught polio-eradication campaign, which over the past decade has been challenged in majority-Muslim areas in Africa and South Asia over beliefs that polio vaccination is actually a covert campaign to harm Muslim children — an accusation that seems fantastic, but begins to make sense when you realize some of those areas have perfectly good reasons to distrust vaccination campaigns.

I take no pleasure in saying the prediction came true. [Read more…]

Borders are Irrelevant: Polio Returns to China

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Very bad news from China, as reported by Xinhua and confirmed by the World Health Organization: For the first time in 12 years, polio paralysis has surfaced in China. Four children, the oldest 2 years old, were diagnosed with polio in mid-July. They all live in Hotan prefecture in Xinjiang province (by weird coincidence, also the site of the latest Chinese food-safety scandal).

The generally accepted math, in polio detection, is that one verified case of polio paralysis represents up to 200 cases of silent infection. Those 200 undetected cases may not experience symptoms, but they can pass on the disease to others. As a result, one case of polio in an area that has been considered polio-free is an emergency. Four cases, as you can imagine, is much worse. [Read more…]

Is Polio Eradication Slipping Out of Reach?

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Over the weekend, I sat in an airport in the midwestern United States for a 12-hour stretch, trying to get a standby seat. Time after time, the goal was in sight — the customer service agents and the video screen hanging from the ceiling all told me I was No. 1 on the waitlist — but every time a flight opened up to boarding, a few higher-priority customers popped up at the last minute and slid onto the list in front of me. The possibility of my getting a seat dangled just out of reach: never impossible, but despite the exhausting wait, never quite achieved.

I suspect this is what polio eradication feels like.

The long effort to wipe the paralyzing disease from the planet, begun in 1988 by a coalition of the World Health Organization, the Centers for Disease Control, UNICEF and the service organization Rotary International (recently joined by the Bill and Melinda Gates Foundation), has several times missed its goal of interrupting all transmission of wild virus — first in 2000, then in 2002 and then again in 2005. The hoped-for date has been moved again, to the end of 2012 this time.

But last week, an independent assessment bluntly warned that the international effort “is not on track to interrupt polio transmission as it planned to do by the end of 2012” and likely will miss that goal as well.

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