The quest for polio eradication is faltering, with millions of children still unvaccinated and insufficient funds available to finish the job, the official monitoring group says in a new report.
Global politics is having a severe impact on vaccination programmes in some parts of the world, according to health officials, with the Taliban banning vaccinations in some parts of Pakistan.
Although ridding India of polio was a “magnificent achievement” and there are now fewer cases of the disease than ever before, a “towering and malevolent statistic” looms over the eradication effort, says the report, written by a World Health Organisation-appointed board chaired by England’s former chief medical officer Sir Liam Donaldson. In the world’s six persistently affected countries, 2.7 million children have never had a dose of polio vaccine.
“[This] 2.7 million is too big a number,” says the report. “It should be sending shockwaves through the leadership of the global programme and through the political and public health leadership of each affected country.
“No one should avert their gaze from the challenge that this number poses. At the global level, at the national level and in cities, towns and villages, the precise reason for all missed children – not just the ones who have never received even one dose – should be laid bare and rapid corrective action taken.”
Difficulties with vaccinations vary from country to country. In north-west Pakistan, a Taliban commander has banned polio vaccines until the US ceases its drone strikes in the region. “Almost every resident in North Waziristan has become a mental patient because of the drone strikes, which are worse than polio,” said a statement from Hafiz Gul Bahadur, who said he had consulted other Taliban leaders before issuing it.
“On one hand the US spends millions of dollars to eliminate polio, while on the other it kills hundreds with the help of its slave, Pakistan.”
Matters were not helped when the CIA was implicated in the recruitment of a Pakistani doctor to go door to door in Abbottabad offering polio vaccination to children while allegedly looking for Osama bin Laden.
Pakistan has been making good progress, although considerable challenges remain, says the report, which focuses on “sanctuaries” in six countries where stubborn reservoirs of polio linger even when the country as a whole appears to be eradicating the disease reasonably well. There are 560,000 children in three areas of Pakistan who have never received a dose of polio vaccine – the third highest number after Congo (640,000) and Nigeria (610,000). The programme in Pakistan, which was seen to be failing last year, has “re-joined the road” to stopping transmission, the report says.
Most alarming is the situation in Nigeria, which has two-thirds of all the cases detected so far this year, and in Afghanistan.
“The risk of an explosive return of polio in Nigeria and west Africa is ever-present and raises the chilling spectre of many deaths and a huge financial outlay to regain control,” says the report. There are four virus sanctuaries, in the northern states of Borno, Kano, Sokoto and Zamfara.
Violence in the north and refusals on religious grounds – despite the efforts of Muslim clerics who have supported polio vaccination – are part of the reason, but the board also has concerns about the performance of the polio programme in Nigeria as a whole.
“Afghanistan is on the critical list,” says the report. “Insecurity has been an explanation for poor performance in the past but it is causing considerable consternation that security has recently begun to show signs of improvement yet case numbers are rising.” Helmand and Kandahar are the worst-affected areas, but insecurity is not the major reason for poor vaccination coverage. Parents are often unaware of vaccination drives and not at home when vaccinators call – if they call at all.
The report also warned the World Health Organisation of a crisis in the eradication campaign as a whole. The recent World Health Assembly responded by declaring polio a global emergency. Health officials fear they could lose the narrow window of opportunity that exists to get rid of the virus completely.
The eradication campaign for 2012-13 has a budget of $2.2bn (£1.4bn), but is $945m short, which has led to the cancellation of some vaccination programmes. Some 94 million children, mostly in west and central Africa, will not get the vaccine they should have received this year, the report warns.
[Unidentified Pakistani girl gets polio vaccine via Asianet-Pakistan / Shutterstock.com]