There’s good and bad news in the current global fight against polio.
In May, the World Health Organization issued a travel advisory for regions of “polio exporters” Syria, Pakistan, and Cameroon. Hamid Jafari, Director of Polio Operations and Research for WHO and the Global Polio Eradication Initiative (GPEI), said during a media briefing held at the UN Foundation that despite the setback in those countries, the “wheels are in motion to finish the job in Nigeria.” Jafari explains that at this point last year Nigeria had 24 cases in nine states reported, but only three cases in two states so far in 2014.
What is obvious in polio immunization campaigns is that “one size doesn’t fit all,” as Peter Crowley Head of Polio for UNICEF noted. However, one strategy that can be applied across the board is country ownership of eradication efforts. Local ownership, combined with international assistance is the crucial combination that can tip a country toward eradication.
In Nigeria, this was achieved in Nigeria by including local philanthropists for ‘home grown’ eradication efforts and making the programs more long-term for routine immunizations. The Nigerian government also saw immunization efforts as an investment in their future economic growth and accepted a loan from Japan to purchase 476 million polio vaccine doses. The government also organized task forces throughout the country, comprised of political, community, and religious figures to implement the National Emergency Plan. Nigerian polio survivors also aided efforts by sharing their stories and educating communities about the need for vaccinating children.
Pakistan’s current security situation mirrors Nigeria’s a few years ago, with certain parts of the country completely inaccessible. In Pakistan, this will likely take the form of more local leadership instead of national government ownership, especially in the northwestern part of the country to which, Jafari says, most reported cases are limited. Crowley noted that part of the issue of local leadership in eradication efforts is the spread of rumors about vaccinations, resulting in attacks on polio workers. Crowley says that “parents do want this vaccine. Acceptance rates and demands are actually high,” despite perceptions.
Imran Khan, who hails from the northwest and is a famous cricket player and politician, has become the face of immunization campaigns in the far reaches of the country, but it is not enough. Pakistani security forces had to be involved in the latest campaign as well. Though if people do not trust armed guards going door to door with polio workers, other means like setting up central facilities or vaccinations on the edges of conflict zones will have to be set up as they have been in Nigeria. Crowley notes that they are seeing “positive signs and a new sense of urgency” from local leaders of late as polio workers decrease the time between their various immunization campaigns.
Another part of the trust issue in the rural parts of Pakistan and in conflict-era Syria is also general lack of access to basic health services. In Nigeria, Jafari noted that thousands of Emergency Operations Centers have been set up. The centers not only administer vaccinations but are equipped to provide other health care services. In Syria’s official and unofficial border crossing points and refugee camps, this coupling of efforts is likely what will have the largest impact in eradication efforts.
Coordination between relief organizations and eradication personnel will be challenging in a conflict zone like Syria, but polio immunizations will need to be considered as large a public health risk as any other immediate refugee need. Luckily, as Rebecca Martin, Director of the Global Immunization Division at the Centers for Disease Control and Prevention (CDC), points out “Syria has a well-informed population with a tradition of high rates of immunization,” so the real issue is just physical access to vaccines. Jafari says there is no real opposition to immunizations by ISIS fighters in Syria, either, but any mobile eradication campaign would need a humanitarian corridor.
Polio is one of many health concerns in places like Pakistan and Syria, with conflict isolating some populations and forcing mass movement of others. Despite the bleak state of affairs, GPEI leaders say eradication is within reach in Nigeria. Its success is because of a combination of government buy-in and coupling of other medical services with immunization campaigns — which seem to be the most crucial factors that if applied to other endemic countries can be key to eradicating polio completely.
Image credit: GPEI