Barriers exist to success of global poliomyelitis eradication program

The interactions of health and national stability are sadly inexorably intertwined. An unfortunate example of this reality is the situation with worldwide elimination of poliomyelitis.

The WHO global polio eradication initiative began in 1988. This program has been very successful, and with its immunization program, has reduced the number of annually diagnosed cases from the hundreds of thousands to under a thousand. There are currently only three countries with endemic poliomyelitis: Afghanistan, Nigeria and Pakistan.

Pakistan led the world in 2011 in total number of cases with 198, followed by Afghanistan with 80 and 62 in Nigeria. As of Dec. 18, 2012, the numbers were 56 for Pakistan, 119 for Nigeria and 34 for Afghanistan. These numbers are small compared to historical numbers, but as long as pockets of disease remain, the potential for spread is great, especially when immunization levels are low.

In 2008, a low immunization rate in northern Nigeria related to rumors spread by fundamentalists, regarding the vaccine, resulted in an outbreak that led to spread of the disease to nine of its neighbors: Benin, Burkina Faso, Chad, Cote d’Ivoire, Ghana, Mali, Niger and Togo that had previously interrupted transmission of the wild poliovirus. The end result of that outbreak, combined with the instability in the country, continued pockets of rumors about the vaccine and the inadequate health care delivery systems is that Nigeria is still one of the few countries in the world with endemic polio.

Pakistan is another of the countries with endemic polio. Unfortunately, the United Nations had to temporarily suspend its polio vaccination activities aimed at the eradication of the disease because of the execution by insurgents of nine immunization workers in different high risk parts of the country. The program has been cautiously resumed, but the threat of violence remains.

The third polio endemic country, Afghanistan, suffered attacks against a polio worker in early December 2012 of this year, leading to the death of a young volunteer vaccinator as well. As long as there is strife in these countries, the chances of totally eradicating polio are questionable.

- Donald Kaye, MD, is a professor of Medicine at Drexel University College of Medicine, Associate Editor of ProMED-mail, Section Editor of News for Clinical Infectious Diseases and is an Infectious Disease News Editorial Board member.