Conflict zones last hurdle to wiping out polio

WHO says money, access and will key to driving vaccine campaigns as world closes in on eradication

Invisible pockets of polio in hard to reach areas – such as conflict zones – threaten a global win in the fight against the paralysing disease, the World Health Organisation has warned, as the goal of total eradication edges closer.

The detection of polio last year in Nigeria’s northeast, an area afflicted by insecurity, “rang a big bell” for global health efforts to map out areas still inaccessible to vaccine drives, said Chris Maher, manager of WHO’s regional polio eradication unit in Jordan. Two children there were diagnosed with wild poliovirus in August, as Nigeria stood a year away from being certified polio-free.

“[A big challenge] is insecurity and conflict. It requires constant negotiation to keep immunising and working in these settings,” said Maher. “I’m most worried about Afghanistan and Pakistan because polio is still endemic there. Like Nigeria, they’ve never stopped local transmission of the poliovirus – everything hinges on that.

“If we can stop that indigenous transmission of the virus then we interrupt the virus everywhere.”

Syria, Iraq, Libya and Yemen are among six countries in the Middle East and North Africa (MENA) tagged by WHO where accessibility to populations is compromised.

Global efforts to wipe out polio are reaching the endgame. In 2016, a total of 37 cases of polio were reported globally - in Nigeria, Afghanistan and Pakistan - down from 74 in 2015 and 359 cases worldwide in 2014. In 1988, the incurable disease was rife in 125 countries paralysing 350,000 people a year.

This year represents the best opportunity to wipe out the disease, according to Maher, thanks to a highly immunised global population after three decades of vaccine drives. In April, 155 countries switched from the trivalent to bivalent oral polio vaccine, as one of the disease’s strains had ceased to exist.

“The longer it takes to get things finished, the more difficult it is to sustain the momentum”Yet big hurdles remain, such as getting vaccines to every child – including setting up teams along transit routes to reach difficult areas, as in Nigeria – finding ways to map infection in conflict-affected zones, and keeping up the enthusiasm among health partners to finish off polio for good, said Maher.  

A further element is money and maintaining the interest of donors. Polio eradication programmes cost $1bn a year globally. Yet, the upside of tackling polio is substantial: a polio-free world would free up $50bn for other health initiatives, according to Oliver Rosenbauer, spokesperson for the Global Polio Eradication Initiative (GPEI), speaking to Philanthropy Age last year. The costs of not doing so are high; as many as 200,000 children could be infected a year, within ten years, if immunisation efforts lag. 

The GCC has played a role in helping the campaign to get to zero. In 2013, the UAE pledged $120m to support global eradication efforts, and again in 2016 it contributed $18.4m, via the WHO, to the Polio Eradication Initiative in Pakistan.

The support helped fund the administration of polio drops to some 10 million Pakistani children, according to GPEI.

This year could arguably offer the last chance to eradicate the disease, Maher said.

“The longer it takes to get things finished, the more difficult it is to sustain the momentum. [Polio vaccination] is a difficult and expensive process,” he said. “As you get to the end, you get fewer cases and less public attention and yet you still need to put the same effort in.

“The last case of polio in India was in January 2011; what worked there was building on the enthusiasm of being so close to the end.”