Persistence is key to wiping out polio outbreaks in fragile nations

Global Health – PBS NewsHour

GWEN IFILL: Public health officials around the world are sounding the alarm this week about the return of polio. It’s a big shift from just two years ago, when some experts thought they were on the verge of eradicating the disease.

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• Polio vaccine campaign faces extemist opposition, public apathy in Pakistan
• Will polio outbreak inspire international community to do more about Syria?
• Program on polio eradication suspended in Pakistan after 9 aid workers killed

Jeffrey Brown has the story.

JEFFREY BROWN: The World Health Organization calls it an extraordinary event that threatens the decades-long battle to wipe out polio.

On Monday, the agency declared an international public health emergency.

Bruce Aylward is leading the WHO polio effort. He spoke during a teleconference from Geneva.

BRUCE AYLWARD, World Health Organization: While the virus has resurged, I think it reminds us that, until it’s eradicated, it is going to spread internationally and it’s going to find and paralyze susceptible kids. Indeed, it could become endemic again in the entire world if we do not complete the eradication of this disease.

JEFFREY BROWN: Worldwide, there have been 74 confirmed cases of polio this year, three times as many as the same period in 2013. They’re focused in Asia, Africa, and the Middle East. In all, the outbreak has spread across at least 10 countries. The WHO singles out Syria, Cameroon and Pakistan as the main sources of the disease. Of those three, the vast majority of cases have been in Pakistan.

FRED DE SAM LAZARO: This slum in Karachi is one of the last places in the world where polio is still a threat.

JEFFREY BROWN: The NewsHour’s Fred de Sam Lazaro visited the country last August. He found Islamist militants have spread propaganda that the polio vaccine makes boys sterile and violates religious values.

Moreover, Taliban militants have killed dozens of polio workers in Northwestern Pakistan.

Dr. Anita Zaidi, a pediatrician, cited a fake vaccination campaign that the CIA used in the hunt for Osama bin Laden.

DR. ANITA ZAIDI, Pediatrician: Which has hugely damaged public health programs, not only in Pakistan, but in many, many countries, because people ask all kinds of questions. They now think that they might — the vaccine programs might be actually spy operations.

JEFFREY BROWN: Now a monitoring board set up by the WHO is warning that Pakistan is a — quote — “powder keg for polio” that could spread the virus on a global scale.

And for a closer look at the outbreak, we turn to Dr. Jon Andrus, deputy director of the Pan American Health Organization, which is part of the WHO.

Welcome to you.

DR. JON ANDRUS, Pan American Health Organization: Thank you.

JEFFREY BROWN: So, declaring a health emergency is a major step. Why now, exactly?

DR. JON ANDRUS: The current situation is a public health emergency of international concern that is going to require a global response in order to prevent the global polio eradication initiative from sinking.

This is going at a time when, in three different countries in three different parts of the world have had importations of wild polio virus due to low levels of coverage and having large outbreaks of paralyzed children.

JEFFREY BROWN: You said wild polio. Explain what that means.

DR. JON ANDRUS: Wild polio is the endemic virus that occurs in nature that paralyzes children.

So, we now have a very good vaccination strategy, but, unfortunately, in these countries, they’re fragile. They may have fragile infrastructure. They may have civil strife. And the countries bordering them are also fragile.

JEFFREY BROWN: What’s striking about this is that, not that long ago, this eradication process was going very well, right, sort of on schedule. So this is relatively new.

DR. JON ANDRUS: Well, it’s — having spent a majority of my life working on polio eradication, you must expect the unexpected.

You never know when these exportations are going to occur. Wars break out. So it’s really being on guard to provide the global response that will prevent this from spreading to neighboring countries. And to that end, the International Health Regulation Emergency Committee was convened by Dr. Margaret Chan, the WHO director, where specific recommendations are provided to stop and mitigate the risk of exportations to other countries.

JEFFREY BROWN: All right, so before I ask you about those, though, I want to talk about some of those specific countries.

Pakistan is one we mentioned in our setup piece, a lot of complications there, political, terrorism, anti-Western sentiment. How do you — how do you cope with that?

DR. JON ANDRUS: It requires a multipronged approach, but I think what we learned in India is persistence.

Today may not be an ideal time, because vaccination — vaccinators are being murdered. But when sufficient commitment and sufficient capacity to approach the problem develops, and that window of time when we take advantage, like India, Pakistan can accomplish the goal.

JEFFREY BROWN: India has been — India is considered a success story in this.

DR. JON ANDRUS: As of a couple of months ago, India was certified as polio-free. So, all of Southeast Asia was certified as polio-free due to India’s success.

Fifteen years ago, the government of India didn’t even think polio could be eradicated. So my point is, it’s persistence. And I think we have a partnership with World Health Organization, UNICEF, the Bill and Melinda Gates Foundation stepping forward, and others like CDC, that will provide that persistence in helping the government stop transmission.

JEFFREY BROWN: Another key country here is Syria. And we have reported on this on the program. Here — there, the case is a real breakdown in just the health infrastructure. Kids just are not getting vaccinations.

DR. JON ANDRUS: Well, during the civil war, vaccinators can’t reach certain areas. So coverage is going to go down. Susceptible children, susceptible to the infection, those numbers will increase.

So, when the virus — as Dr. Aylward mentioned, the virus is going to find those children. And the outbreaks that we have seen have occurred. Now Syria is exporting the virus, most recently to Iraq, which is another country that’s fragile and will be difficult to control.

JEFFREY BROWN: So, tell us a little about the measure that can take place. WHO doesn’t have enforcement provisions, right? But you’re recommending — well, some of it has to do with travel restrictions.

DR. JON ANDRUS: Well, the international health regulations, which were modified in 2005, adopted by the World Health Assembly — so that is a governing body that all member countries participate in — they approved these regulations that injects a level of accountability to the countries that have the problem.

So, in the old days, when the international health regulations were only limited to a small number of diseases, mainly smallpox, cholera, plague, and yellow fever, with a one-size-fits-all strategy, we now have regulations that can be adjusted and — and tailored to the situation.

It’s not just about an infectious disease. It could be about an earthquake, as happened in Haiti. It could be about a tsunami that happened in Indonesia. So those regulations, we believe, add accountability and really, through the global community, encourage local action at the source of the infection, whereas, in the old days, it was at the border crossings.

JEFFREY BROWN: I see.

DR. JON ANDRUS: So now it’s…

JEFFREY BROWN: So, now it’s a mix.

DR. JON ANDRUS: It’s a mix. And I think does add accountability.

So, specifically, the director of WHO is asking those three countries that are exporting the virus — namely, Pakistan, Cameroon and Syria — any traveler that plans to leave the country be required to be vaccinated four weeks before they leave, up to a year.

But that then would be documented with the WHO forms, and would be a mechanism to mitigate the risk of it being exported.

JEFFREY BROWN: OK.

Dr. Jon Andrus of the World Health Organization, thanks so much.

DR. JON ANDRUS: Thank you, Jeff.

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