Polio, a dangerous and even deadly infectious disease, is a distant memory for many global citizens. We have never known life without it.
Despite growing up in two countries — Pakistan (Z.B.) and Cameroon (R.L.) — separated by 7,000 kilometers, we both know what it is like to live and work in communities plagued by polio. As a physician, one of us (Z.B.) has sat beside countless parents as they come to terms with the life-long disability, and sometimes even death, of their child. As a researcher, the other (R.L.) has met with numerous affected families who are struggling with the financial and emotional burden of their new reality. We have both seen far too many children paralyzed by this awful virus and are often reminded of it by crippled adults.
Amid this devastation, we have also seen incredible progress toward stopping polio. Since 1988, when some 350,000 children were paralyzed by polio each year, the number of annual cases has been reduced by more than 99%, thanks to the tireless efforts of frontline workers, communities, local governments, and global partners. The challenge now lies in preventing the remaining 1% of cases. That’s important because this 1% provides a reservoir that can easily be transmitted to people in any country.
Last month, the world stepped up to back these efforts, as donors and governments pledged $2.6 billion at the World Health Summit in Berlin to fund the Global Polio Eradication Initiative. At the same time, the two of us partnered with more than 3,200 scientists, physicians, and public health experts from more than 115 countries to launch a Scientific Declaration on Polio Eradication, calling for the word to urgently end polio for good.
This renewed commitment to eradication by donors, governments, and global experts has been remarkable. But the world needs more financial and political resources to finish the job.
The experiences of our home countries have shown us both that the knowledge and tools exist to achieve a polio-free world. Pakistan is now one of the last two countries in the world where polio is endemic — meaning the wild form of the virus still circulates — but it has seen far fewer cases in the last 12 months (20) than in 2020 (84) and 2019 (147). Just two years ago, the whole African region was declared free of wild poliovirus.
Meanwhile, Cameroon has managed to keep outbreaks of circulating vaccine-derived poliovirus at bay. These are rare forms of the virus that affect many other countries in Africa. Vaccine-derived polio emerges when the weakened virus contained in the oral polio vaccine, which is shed by vaccinated children, circulates in under-immunized populations long enough to slowly regain the power to cause paralysis. While there are still hurdles on the road to stopping transmission of wild and vaccine-derived polio and end polio outbreaks everywhere, tactics have been honed over the last two decades to overcome them. Future progress rests on three key pillars: surveillance, vaccination, and innovation.
Strong surveillance systems allow public health officials to track polio wherever it is circulating and respond rapidly to any trace of the virus. As we write this, health workers around the world are opening sewers to collect samples of wastewater and sending them off to a global network of laboratories to be tested. Others are carefully watching for any signs of the disease in their communities to sound the alarm after a single polio case is detected. Pakistan’s robust surveillance system, for instance, has been instrumental in its progress toward reducing polio and should be mirrored globally.
Surveillance, however, is not enough on its own. It must be paired with high-quality campaigns that deliver vaccines to children everywhere. These are made possible by dedicated health workers who travel, rain or shine, by car, motorcycle, bike, boat, and foot, knocking on doors until all children have been vaccinated against polio. They talk with members of their communities — from a child’s parents to influential religious leaders — to address their concerns and build trust in the polio vaccine. These efforts are the best and only way to ensure that all children are protected against polio.
Ending polio also requires using new tools to address old problems. Twenty African countries have led the way in the administration of one such tool: the novel oral polio vaccine type 2 (nOPV2), an innovative vaccine that will more sustainably stop variant polio outbreaks. This vaccine, which has been in development since 2011, is a modified version of the traditional oral vaccine that is designed to be more genetically stable and so less likely to revert to a form that can cause paralysis. So far, 500 million doses of nOPV2 have been administered around the world, 95% of which have been given to African children.
New technologies are also being deployed to bolster vaccinations. In Pakistan, a WhatsApp hotline is being used to combat misinformation. In Nigeria, health workers are being paid through their mobile phones to ensure they are quickly and reliably compensated for their important work.
Challenges like Covid-19 and natural disasters have disrupted polio-fighting activities in many countries, creating the condition for the virus to thrive and threaten people around the world. It was a tragedy this year when a strain of wild poliovirus originating in Pakistan was found again in Malawi and Mozambique, and variant poliovirus spread to the United States and United Kingdom. But these episodes also serve as warnings of what can happen if the world backs down now.
Polio, like every virus, knows no borders. But we are both confident that with the support of the global community, the Global Polio Eradication Initiative can carry out all the strategies known to stop polio in its tracks.
People like us in countries long affected by polio are doing our part to eradicate this disease, but we can’t do it alone. It’s time for the rest of the world to step up in full support of the global initiative to stop polio for good.
Rose Gana Fomban Leke is an infectious disease specialist, chair of the Africa Regional Commission for the Certification of the Eradication of Poliomyelitis and professor of immunology and parasitology at the University of Yaoundé in Cameroon. Zulfiqar Bhutta is a pediatrician, chair of Global Child Health at the Hospital for Sick Children in Toronto, and distinguished university professor of pediatrics and child health at Aga Khan University in Karachi, Pakistan.
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