polio Archives - Maryn McKenna

Get Your Shots, Wash Your Hands, Thanks, and Goodbye

March 27, 2015 By Maryn Leave a Comment

icenine-exit

IceNine (CC), on Flickr

A little less than 5 years ago, editor Betsy Mason of WIRED Science called to ask whether I’d be interested in joining a new thing. WIRED was thinking about starting a science blog platform; she wondered whether I’d want to be one of the bloggers.

I did very much want: WIRED is both a great magazine, with inspiring storytelling and innovative design, and a brand with international reach. I was a bit perplexed why they would want me — scary diseases didn’t seem like a core interest for WIRED readers — but Betsy (now one of the authors of WIRED’s Map Lab blog) was confident the audience was there.

She was right. Superbug debuted Sept. 14, 2010 with a report on the “Indian superbug,” the antibiotic resistance factor NDM that was then just starting to move across the world. My second post explored “livestock MRSA,” the bacterium that originates in antibiotic overuse in agriculture, and the third looked at the shivery subject of a rare and deadly parasite transmitted by organ transplants. Those three posts pretty much defined Superbug’s turf: public health, global health, and food policy, with a sprinkle of dread. Readers responded with fascination and good will, then and to the more than 300 posts afterward.

Of which, as you’ve probably guessed, this is the last. Superbug has had a fantastic run, but there was only one other place I wanted to work, and I’m headed there. Next week, I’ll be joining National Geographic’s Phenomena under a new blog name.

(Worth saying: This move is coincident with Wired.com’s redesign, but is not at all related. Phenomena happened to have a rare opening.)

A New Polio Case in Pakistan and an Unsolved Epidemic

January 21, 2015 By Maryn Leave a Comment

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.

A World Cup Visitor: Polio from Africa in Brazil

June 25, 2014 By Maryn Leave a Comment

Eutroph-outflow

Gerick Bergsma via Eutrophication & Hypoxia / Flickr

Unnerving news from Brazil, now hosting travelers from all over the world because of the World Cup: The virus that causes polio has been found in sewage in one of the cities where matches are being played.

The World Health Organization, which announced the finding on Monday, says the virus was discovered last week in a sample collected in March at Viracopos International Airport in Campinas, which is about 60 miles outside Sao Paulo, and is where many of the World Cup teams have been landing. The agency said no cases of polio have been identified and there is no evidence the disease has been transmitted.

Genetic sequencing of the virus—the WHO didn’t say, but probably done by the Centers for Disease Control and Prevention in Atlanta—revealed that it was closely related to a poliovirus that recently caused a case of the disease in Equatorial Guinea in West Africa. Humans are polio’s only host; so that probably means the virus was carried into Brazil by a traveler, likely someone who never knew he was harboring it.

Brazil, like most of the rest of the world, continues to vaccinate against polio, even though there have been no cases of polio in Brazil since 1989, and the Americas were declared polio-free in 1991. The high vaccination rate — 95 percent of children nationwide, and higher than that in Sao Paulo State — kept the virus from spreading.

Still: not good.

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

May 20, 2014 By Maryn Leave a Comment

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.)

Polio Declared An International Health Emergency

May 6, 2014 By Maryn Leave a Comment

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.

Polio Eradication: The Bad News Continues

January 10, 2013 By Maryn Leave a Comment

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.

Taliban Murders Six Immunizers in Wake of CIA Polio Ruse

December 18, 2012 By Maryn Leave a Comment

(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.

Update: Pakistan, Polio, Fake Vaccines And The CIA

May 23, 2012 By Maryn Leave a Comment

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…]

Scathing Report: Polio Eradication "Not… Any Time Soon"

October 22, 2011 By Maryn Leave a Comment

An independent monitoring board convened by the worldwide polio-eradication initiative has delivered a report on the global effort that is striking for its brutally frank and even frustrated tone.

Among its findings, just in its first few pages: “Case numbers are rising”; “unwelcome surprises continue”; “as many milestones are being missed as are being met”; and “the (eradication) Programme is not on track for its end-2012 goal, or for any time soon after unless fundamental problems are tackled.”

Possibly the biggest problem, the board concludes, is a get-it-done optimism so ingrained in the 23-year effort that it cannot acknowledge when things are not working:

We have observed that the Programme:

Is not wholly open to critical voices, perceiving them as too negative – despite the fact that they may be reporting important information from which the Programme could benefit.

Tends to believe that observed dysfunctions are confined to the particular geography in which they occur, rather than being indicative of broader systemic problems.

Displays nervousness in openly discussing difficult or negative items.

If some of this sounds familiar, that is because the board hit similar notes in its last report in July, in which it declared that the international effort “is not on track to interrupt polio transmission as it planned to do by the end of 2012.” I get the sense, reading the latest, that the board does not believe it was heard.

Borders are Irrelevant: Polio Returns to China

August 29, 2011 By Maryn Leave a Comment

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…]

How a U.S. Court Case Explains Problems Eradicating Polio

August 15, 2011 By Maryn Leave a Comment

One of the perennial problems blocking polio eradication is the persistent belief that the rounds of vaccination meant to protect children are actually a covert campaign to harm them. I’ve seen it myself, in my reporting, and studies examining the 23-year effort’s inability to get to zero describe it as well.

From the sanitized safety of the industrialized world, it’s hard to imagine how any neighborhood or tribe could hold such views. Which is why the report on Friday of news regarding a 15-year-old court case is so important. The actions that prompted the case created mistrust so long-lasting that it undermines unrelated medical campaigns, including polio, today.

Is Polio Eradication Slipping Out of Reach?

July 26, 2011 By Maryn Leave a Comment

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.

File Under WTF: Did the CIA Fake a Vaccination Campaign?

July 13, 2011 By Maryn Leave a Comment

A number of years ago, I was in New Delhi, at the end of an exhausting 18 hours in which I had torn around the city to watch a National Immunization Day. On those days — like a national holiday, with flags and banners and kids let out from school — tens of millions of children line up to stick out their tongues and receive the sugary drops that contain the vaccine that should protect them against polio.

The Indian government, along with the Centers for Disease Control, the World Health Organization and the volunteer ground troops of Rotary International, has been organizing these days now for most of two decades, always coming closer to the goal of eradicating polio, never quite getting there. On this day, which occurred close to the end of weeks I had spent embedded with a WHO “STOP Polio” team, 135 million children were expected to queue in cities and suburbs and rich neighborhoods and slums. I spent the day with the team I had been observing, racing in a battered turquoise Tata from neighborhood to neighborhood, trying to understand where the campaign’s message was working and where its earnest persuasions had failed. (You can read my account of the day here.)

WCSJ: Maybe The Biggest Disease Threat Isn't Infectious At All

July 1, 2011 By Maryn Leave a Comment

I’ve been away the past week at the World Conference of Science Journalists, a biannual gathering that brought 726 writers and broadcasters from 87 countries to Doha, Qatar. I was there to give a presentation about blogging, and also because I organized two panels on under-reported epidemics and on food and farming issues in the developing world. My panelists’ testimony was so powerful that I wanted to share some of the details.

Going into the conference, the epidemics panel was my favorite. That’s not because I cheated and made myself one of the speakers, but because it brought into public view so many of the disease-control issues that we talk about here. When I say hidden epidemics, what I mean is this: The diseases that routinely grab headlines are almost never the ones that cost society the most in illness and deaths, and also in money to control and repair them.

Think of Ebola, for instance. There has never been a case of human Ebola in the United States. And as I’ve written before, viral hemorrhagic fevers repeatedly have been imported to North America without ever starting an outbreak. Yet whenever Ebola sparks in Africa, it earns scare-font headlines here, as though it were about to rampage across the continent — even though, in all its known engagements with humans, Ebola has killed less than one-tenth of the 19,000 that MRSA, for instance, kills in the US in a single year.

I asked a set of distinguished health journalists, all friends, to come to Doha to talk about diseases that deserve headlines, but never get them. Here’s what they said:

Polio eradication: Not over for a while yet and why

March 30, 2011 By Maryn Leave a Comment

The news on polio eradication — the almost 30-year up-and-down struggle to make polio the second human disease, after smallpox, to be eradicated from the planet — recently has been wonderful. The case numbers are seesawing — fewer in the four countries where the disease remains endemic, more in the countries where has recently crept back — but overall much lower than just a few years ago. The game-changer has been the entry into the eradication fight of the Gates Foundation, which has declared polio one of its major priorities. That infuses a huge bolus of cash into an effort that was always short of funds, but even more it shines a spotlight of international attention on a mostly neglected disease. Where Gates goes, governments and the media follow.

But before expectations of success rise too high, it is important to say that there is a largely unexplored and difficult end-game to polio eradication. It is smartly captured in an essay by Debora MacKenzie of New Scientist, who reminds us that ending all cases of wild-type polio will only be the end of the beginning — because we will still have to protect the world from the virus that we have been using all these years in the vaccine. [Read more…]

Spreading cholera, maybe polio: Now will we care about Haiti?

January 27, 2011 By Maryn Leave a Comment

It’s been two weeks since the one-year anniversary of the devastating Haitian earthquake, and the ongoing crisis in that desperately poor island has once again sunk below the news-radar horizon. Which is of course outrageous: Most of the infrastructure has still not been rebuilt, and 800,000 people are still living in tent cities parked precariously in the rubble. The non-profit Oxfam has pinned some of the responsibility on Haiti’s long-standing political chaos: “It doesn’t matter how much money you pour in unless you build up a government that is strong enough to take decisions.” Simultaneously, the United Nation’s special envoy, former Canadian Governor-General Michaelle Jean, has scolded the industrialized world in an open letter published on the anniversary: “What began as a natural disaster is becoming a disgraceful reflection on the international community.”

Well, maybe this will get their attention.

Polio follow-up: Polio-free and then not

November 5, 2010 By Maryn Leave a Comment

I talked on Monday about the risks to the worldwide polio eradication campaign of vaccine-derived polio (VDPV), the mutated form of the vaccine virus. New bulletins from the World Health Organization and the Centers for Disease Control and Prevention remind us that original wild polio can bounce back in perilous ways as well.

The WHO said Thursday that Congo, which saw its last case of wild-type polio in 2000, is in the midst of an outbreak that so far has racked up 120 cases of paralysis and 58 deaths, with half the cases occurring just in the last 10 days. (That’s the Republic of Congo, AKA Congo-Brazzaville. As distinguished from the Democratic Republic of the Congo, AKA the former Zaire, with which it shares a border. Clear?) In polio circles, every case of paralysis is taken to represent from 150 to 200 cases in which people experience no symptoms but are still carrying and transmitting the virus — so this outbreak is very large, and still growing.

Polio in India: Many steps up… and a long one back

November 1, 2010 By Maryn Leave a Comment

Discouraging news from India, in the long campaign of polio eradication that has seen so many ups and downs (my last post on polio here): A girl who was vaccinated against polio in one of the enormous national campaigns held every few months there has become paralyzed. But not for the reason that is usual in India, that the vaccine did not take and she became infected with wild-type polio. Instead, her paralysis was caused by the vaccine virus itself, mutating back to infectiousness and causing what’s known as vaccine-derived polio or VDPV.

As reported in the Telegraph of Calcutta and the Deccan Chronicle, the 9-year-old’s case raised alarms because she lives in the state of Tamil Nadu, which has been polio-free for 4 years. Then she was discovered to be infected with polio virus type 2, which was eliminated in India 10 years ago but still is being vaccinated against, in case it returns. (There are three types.) She is one of three children in India to develop VDPV this year; 15 chldren there did last year. Ironically, only a few days before her case was announced, another newspaper, the Deccan Herald, cautioned that the possibility of VDPV was a “ticking time bomb” that could derail polio eradication if not closely watched.

VDPV is one of the ever-present complexities of polio eradication. It poses a significant risk to the campaign’s end-game that really hasn’t been publicly discussed.
[Read more…]

Past time to pay attention to polio

June 28, 2010 By Maryn Leave a Comment

In the winter of 1999, I stood in an outpatient clinic in a pediatric hospital in New Delhi and listened to a father sobbing over the paralysis of his only son. He was a farmer and lived in Uttar Pradesh; counting walks, minibuses and trains, it had taken him 24 hours to get to the hospital. He had carried the toddler the entire way.

His son had gotten the drops, he insisted: Every time the teams came to his neighborhood — which they did three, four times each year — he or his wife had lined up all their children, the boy and his older sisters. His son had had 11, 12 doses, the man said. How could he have gotten polio? And it was polio, the doctor treating him confirmed, not one of the transient febrile paralyses that exist alongside the disease and make detection and diagnosis so complex in resource-poor settings. She saw this all the time, she confided. The massive polio-eradication campaigns that continually blanketed India had trouble reaching some resistant populations, and those children contracted polio because they were not vaccinated — but children whose parents were compliant, who believed in the drops and made sure their children received them, became paralyzed as well.

I was in India that winter because the long-hoped-for goal of the worldwide eradication of polio was supposed to be achieved the following year, in 2000. The global eradication initiative — led by the WHO, the CDC and a massive volunteer effort by Rotary International — didn’t make that goal that year. Or in 2002, or in 2005. For a variety of reasons, from the biology of the disease in the tropics to political manipulation in service of unrelated ends, several countries have remained stubborn hot spots. And as long as the disease persists within their borders, it can leak outside them and become re-established in any area where vaccination has slowed down because the goal of stopping local transmission appears to have been achieved.