The Front Lines in the War on Polio

While I would prefer not to use a war metaphor for the effort to eradicate poverty—there is enough war in the world—the imagery is apt. There is an enemy, the polio virus, and an army, the 20 million health care workers engaged in polio vaccinations around the world, and victims, mostly children who must be protected.

The battles front lines are in Pakistan and Afghanistan. With many of Afghanistan’s polio cases in recent years tied to Pakistan, it is safe to say that Pakistan is where the action is. You see, Pakistan and Afghanistan are the only countries on earth that have never eradicated polio and they are the only two countries in the world to have polio cases in 2016.

Afghanistan has reported five cases of polio so far this year, up from one at this point last year. Pakistan has had just 9, down from dozens last year.

To put that in perspective, India reported its last case of polio in January of 2011. There were 42 cases of polio in India in 2010. We are clearly seeing polio in its final stages, but can the world achieve global eradication in 2016?

That is the question I seek to answer in my visit to Pakistan this week.

The polio eradication effort was announced by Rotary International in 1985. Despite the announcement, large scale efforts weren’t undertaken until 1988, when the U.S. Centers for Disease Control signed on as a partner in the “Polio Plus” effort. The “Plus” was a reference to routine immunizations. Soon, UNICEF and later the World Health Organization (WHO) would join the fight. Later still, the Bill and Melinda Gates Foundation would join the partnership that came to be called the Global Polio Eradication Initiative or GPEI.

Today, the Gates Foundation is by far the largest funder of the fight to eradicate polio, but their aggregate funding isn’t much more than the $1.5 billion provided by Rotary over the 30 years it is had the effort. The Gates Foundation now matches Rotary donations 2 to 1 and makes additional donations to UNICEF and others to support polio eradication.

Ultimately, however, the efforts of these large NGOs (non-governmental organizations) serves to catalyze and support the work of governments around the world whose participation has proven essential.

Children celebrate polio eradication in India in 2014., by Devin Thorpe

In India, for instance, when the Rotary effort began in the late 1980s, the work was viewed by the volunteers as impossible. Each year, 170 million children needed to be vaccinated several times in order to stem the spread of the disease. Rotarians took comfort in the knowledge that the children they immunized were less likely to get the disease (several doses are required to achieve 90 percent immunity).

In the early 2000s, however, the Indian Government recognized that with the help and support of the GPEI members, polio could be eradicated in India. All levels of government from local to national engaged and adopted polio eradication as a universal objective. In 2014, the WHO declared the country officially polio free. The success was a function of collaboration among all levels of government and all members of the GPEI.

So, will 2016 be the year of the last case of polio in Pakistan. We all hoped it would be, but hopes are dimming. Polio has a low season in the late winter and early spring and a high season in summer and fall. As Pakistan moves into the sweltering weather of summer, the virus appears to be in circulation, suggesting we may wait until early 2017 to see the last case.

My trip, premature though it may be, reflects my personal optimism that polio will be eradicated soon. Visiting Pakistan will give me an opportunity to explore the challenges that have prevented eradication in this region and learn what is being done to combat the virus and exterminate it once and for all.

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