The road to polio eradication has been nothing if not torturous. The initiative is credited with spectacular achievements - reducing the number of cases by more than 99 percent, providing vaccinations and other health services to children previously unreached, engendering scientific research to better track infectious diseases. But just as the effort seems closest to its ultimate destination, roadblocks appear. In 2003, it was a ban on polio immunizations in northern Nigeria that led to reinfection in 20 other countries. Starting in 2012, polio vaccinators in Pakistan were killed in brazen attacks on the program. In 2013 and 2014, an outbreak in the Horn of Africa paralyzed more than 200.
We are now at another point where this audacious goal is tantalizingly within reach. There were only 37 cases of polio recorded worldwide in 2016-17 compared to an estimated 350,000 when the initiative began in 1988. As a result, millions of children have been saved from the terror and disfigurement of polio paralysis. Millions of parents won't have to watch their children suffer an agonizing, life-altering fate.
But, despite being so close to success, obstacles continue to arise. The number of displaced people is at its highest level since World War II, providing a daunting challenge to global immunization. Insecurity along the Pakistan/Afghanistan border and in the Lake Chad region prevents vaccinators from reaching susceptible children. Perhaps most threatening, donor countries are grappling with their ability to contribute to long-term global stability and disease reduction amid the increasingly domestic concerns of many in their populations.
Polio-affected countries along with Global Polio Eradication Initiative (GPEI) leadership are continuously finding new ways to confront the insecurity and complacency dogging the program's final push. The Pakistan army in 2015 cleared out a large patch of previously inaccessible FATA [Federally Administered Tribal Areas], allowing vaccinators to immunize children as they moved across the border. Similarly opportunistic approaches are now being carried out near Lake Chad where an estimated 500,000 children in Borno state alone are beyond the program's reach.
But all these courageous, inventive undertakings are wasted if the rest of the world backs off its commitment to eradicating polio. While perhaps not fully aware of what they were promising, and certainly not how long it would take, all UN [United Nations] member states agreed nearly three decades ago to unite against this disease. Countries with solid immunization systems eliminated it fairly handily. But some countries did not have the will, infrastructure, or resources to keep pace. The clear majority of the GPEI’s [US]$1 billion annual budget now helps the world's least developed countries buy vaccine, conduct disease surveillance for polio and other vaccine-preventable diseases, and provide essential immunization staff.
Eradicating polio is, as former CDC [Centers for Disease Control and Prevention] director Tom Frieden said, "forever and for everyone." It is the ultimate in health equity since it provides the same protection to poor children as it does to rich. Further, the initiative has produced a unique and valuable collection of tools - including a global laboratory system and effective public/private collaborations - that can be applied to other pressing public health concerns.
But the job isn't over until the last case of polio has been recorded and the world undergoes a three-year certification period. Nigeria experienced the pitfalls of premature celebration and complacency in 2016, when after two years without a reported case, it found a hidden polio reservoir. The discovery forced the populous African nation back on the short list of countries where the disease has never been interrupted and vividly illustrated that all must remain committed to eradication until global certification is achieved.
Especially the United States [U.S.]. For many Americans, polio is a disease of their grandmother's generation. But inspired by smallpox eradication in the 1970's, U.S. public health leaders saw the potential for polio's global demise and helped push the world to take on the challenge. GPEI leadership throughout the program's history has made substantial use of U.S. technical and policy expertise as well as its financial resources.
As a primary driver of the initiative and one of its most stalwart supporters, continued engagement by the U.S. government is essential to eradication's success. The newly developing America First agenda should take a broad view, keeping eradication's impact firmly in mind. It should encourage fierce U.S. commitment to stopping polio transmission and then to poliovirus containment and post-certification activities. It should adopt a proactive stance to repurposing polio infrastructure to other health advances.
Continuing dedication to polio eradication through its final stages advances U.S. interests by bolstering weak health systems, thus increasing global stability and making the world safer for all. It protects Americans from infectious disease by tackling outbreaks where they arise. Finally, it both enhances the U.S. image as a leader in health improvements worldwide and provides a sustained return on investment for the generous eradication funding provided by American taxpayers.
These are tumultuous times. The world needs a win. Eradicating polio will provide an achievement that shows we are, in fact, all in this together and with that spirit, able to confront our mutual challenges with vision and determination.
Nellie Bristol, MA is a senior fellow with the Center for Strategic and International Studies (CSIS) Global Health Policy Center who has written extensively on polio eradication. Bristol came to CSIS following a long career as a health policy journalist. In addition to polio eradication, she has covered issues such as HIV/AIDS policy, foreign aid and national security, noncommunicable diseases, and efforts to combat maternal mortality.