Fight against polio falters in Pakistan and Afghanistan

The World Health Organisation is frustrated by the failure to eradicate the disease

A Pakistani health worker administers polio vaccine drops to a child during a polio vaccination campaign in Islamabad on December 12, 2018. AFP

The global fight to stamp out polio has faltered in Pakistan and Afghanistan and may be going backwards, according to the eradication chief of the United Nations' health agency.

The World Health Organisation's polio eradication director said the drive to wipe out the crippling disease had stagnated in the virus' two last haunts.

While progress continued to be made in Africa, vaccinators had failed to stop the circulation of wild poliovirus in Pakistan and Afghanistan and cases had risen in 2018, Michel Zaffran told The National.

As long as the virus remained in these holdouts, there was the chance that it could spread and flare up again in countries long considered clear. Shattered Middle Eastern countries such as Yemen and Syria could be particularly vulnerable.

Yet despite the setbacks, he said one strain, called type 3 poliovirus, is set to be formally declared eradicated in the next 12 months or so, after not being spotted for more than six years.

By last week, 2018 had seen 29 worldwide cases of wild poliovirus, all in Afghanistan and Pakistan, up from 22 the year before.

“We are disappointed and frustrated by our inability to interrupt the circulation of the virus in Pakistan and Afghanistan,” he said.

“Of course we are trying to look also at the glass half full. It's clearly a failure on our part to not be able to interrupt the circulation in the remaining endemic bloc.

“In Pakistan and Afghanistan, it certainly is stagnation and perhaps even a step back given we have more cases in Afghanistan and more children inaccessible than we did in the beginning of the year. And in Pakistan we have been unable to stop the circulation in the key reservoir which for me is not only a stagnation, but also an indication that because we are stopping to make progress, we actually are in a way going backwards.”

Worsening security in Afghanistan is leaving more children beyond the reach of vaccinators, but he said the problem in Pakistan, where security has improved sharply in recent years, was poor management.

“We need to do a better job – and this we haven't done – at vaccinating and protecting the children where we have access,” Mr Zaffran said. “In Pakistan, it's not an access issue, in Pakistan it's really a management issue, it's quality of vaccination, it’s tracking the children that are highly mobile.”

Pakistani officials complain they are having to tackle a migrating population drifting back and forth across the Afghan border.

A global coalition has in the past 30 years brought polio to the brink of extinction. When the Global Polio Eradication Initiative began in 1988, the wild polio virus was present in 125 countries, with approximately 1,000 children being paralysed each day. But the vast majority of the reduction to the current handful of cases took place in the early years and the final mile is proving stubbornly hard.

On the positive side, Mr Zaffran said, no wild virus had been detected in Africa for two years. There had been fears the virus still existed in parts of Nigeria under Boko Haram militant control, but as health workers had slowly gained access to the children there, they have not found the disease.

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Type 3 of the virus had not been seen since 2012 said Mr Zaffran. Type 2 of the virus was declared eradicated in 2015.

“We are pretty confident now, but of course it's not been made official, that the wild virus type 3 has been eradicated,” he said.

For all the difficulties, he said it was critical not to lose momentum, or to become complacent, in the final stretch of eradicating polio overall. "If we stopped our efforts now and we left Pakistan and Afghanistan without any support to interrupt the circulation, then all that we have achieved over the last 30 years could actually be lost."