Polio is rarely given a thought in the U.S. these days.

We take it for granted since our last case of wild poliomyelitis was treated in 1979. For most of us, polio is a disease from a different era.

The poliovirus is very contagious and spreads by person-to-person contact. Just like COVID-19, people without symptoms can still infect others and an epidemic can occur almost without warning.

A series of polio epidemics in the U.S. from 1894 to the 1950’s created a public panic that led to the development of the March of Dimes and a drive to eradicate the disease.

Thankfully, due to the ground-breaking work of Jonas Salk and Albert Bruce Sabin, millions of lives have been saved. Due to vaccination efforts, U.S. cases of paralytic polio plummeted by the end of the 1960’s.

Unfortunately, this was not the case for every country.

In 1987, 125 countries worldwide were still wrestling with polio and over 350,000 children were still being paralyzed by the virus annually. Therefore, in 1988, the World Health Assembly voted to approve the Global Polio Eradication Initiative (GPEI).

Since then, public health officials have eradicated two of the three strains of polio worldwide. It was thought the third strain is on the verge of disappearing.

GPEI set a goal to eradicate polio completely by 2023. Unfortunately, 2020 and the pandemic have not been helpful to the project.

Last year saw significant setbacks with over 200 cases of wild type 3 polio and 600 cases of vaccine-derived polio. Most of these cases have occurred in Afghanistan and Pakistan.

There are two main causes for the rise in cases.

First, an inability to vaccinate children.

Due to the pandemic and the lack of access in Taliban-controlled areas of Afghanistan, public health workers have had to scale back vaccine efforts. For almost three years, public health workers have been banned from polio activities in many provinces controlled by the Taliban.

With the Taliban solidifying its control over the country following the U.S. withdrawal, experts are concerned about the future of polio eradication efforts in the region. With almost three years of unvaccinated children in southern Afghanistan, many are bracing for an explosion of new cases.

Second, water, sanitation and hygiene (WASH) practices.

Vaccine-derived polio is caused by remnants of a weakened form of the live type 2 poliovirus that was used in the oral polio vaccines. The vaccine is ingested and, during digestion, causes the body to produce an immune response protecting the person receiving the vaccine.

A rare side effect is that a vaccinated person will excrete feces infected with this weakened stain. If infected feces contacts water or food sources, the weakened virus from the vaccine can replicate and strengthen itself. In some cases, it can be as dangerous as the original virus.

This is typically not a problem for individuals who have been vaccinated, so it should not be seen as a problem with the vaccine but a matter of improving public sanitation.

UNICEF reports that while 67% of Afghans have access to clean water sources and 80% of families have access to toilets, only 43% of the toilets are “hygienically separate human waste from human contact.”

In addition, “open defecation continues to be a dangerous challenge in Afghanistan because human waste near waterways and living environments spreads diseases quickly and puts children and their families at risk.”

Herein lies the problem. To eradicate polio, public health workers need to vaccinate as many as possible and help upgrade WASH in under-developed communities. This is unlikely to happen in war-torn countries or places that the UN has limited access.

This situation in Afghanistan teaches us two important lessons.

1. All actions have consequences – economic, moral and political – that must be considered.

Whether it was morally right or wrong for the U.S. to withdraw from Afghanistan is not the point here. The point is that there are unforeseen consequences to all actions. All political and foreign policy decisions will generate unintended consequences.

For example, if Taliban leaders continue to restrict immunization efforts, then the country could see an epidemic of cases which can and will flood over into Pakistan, Turkmenistan, Tajikistan and probably Iran and China, as well.

Because of the success of public health officials in eradicating polio, many developed countries have stopped vaccinating for the disease. Therefore, if such a mass outbreak were to occur, it theoretically could have significant consequences for the unvaccinated children in developed countries.

2. We are not alone and should not make decisions alone.

It is erroneous thinking when we assume we can live in isolation. We no longer live in the dark ages.

The COVID-19 pandemic has reminded us that ours is a global economy and that the world is now a global community. What happens to one of us happens to all of us.

In the case of public health, we often forget that if a virus thrives anywhere, then it is a threat everywhere. This applies to terrorism, poverty, lack of education and discrimination.

While patriotism is great, nationalism is harmful. We need to view ourselves as citizens of the world and start evaluating our decision from a global perspective.

Our ability to stop the next pandemic may depend upon it.

Share This