Sunday December 15, 2019

Final push against Polio begins today in 150 countries

From April 17 to May 1, 150 countries will engage in a synchronized switch to a bivalent, or two-strain, vaccine that contains no type 2 virus but targets types 1 and 3

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A girl receives polio vaccine drops at a government dispensary in a Karachi slum, Pakistan in this October 21, 2014 file photo. REUTERS/Akhtar Soomro/Files
A girl receives a polio vaccination outside her house in Yemen's capital Sanaa in this November 9, 2015 file photo. REUTERS/Khaled Abdullah/Files
A girl receives a polio vaccination outside her house in Yemen’s capital Sanaa in this November 9, 2015 file photo. REUTERS/Khaled Abdullah/Files

By Kate Kelland

LONDON, (Reuters) – In a huge immunization effort in 150 countries, health teams will on Sunday launch what they hope will be the final push against polio.

Stopping transmission of the contagious viral disease that has infected millions is possible within a year, experts say. And full, official, global eradication could be declared by the end of this decade.

First, however, the vaccine that has successfully fought polio for more than 30 years needs to be switched for one that targets the last few areas of risk.

It won’t be easy, or cheap, but the World Health Organization’s director of polio eradication, Michel Zaffran, says failure now – when there have only been 12 cases worldwide this year, in Pakistan and Afghanistan – means the virus could spread across borders again.

Success would make polio only the second human disease to be eradicated since smallpox was banished in 1980.

“Taking our foot off the pedal now could mean polio will within a few years spread straight back into large parts of the world and create 100,000 or 200,000 cases,” Zaffran told Reuters. “The job has not been done and will not be done until we have fully eradicated the virus.”

A man suffering from polio crawls outside a row of closed shops in Siliguri, India in this December 8, 2006 file photo. REUTERS/Rupak De Chowdhuri/Files
A man suffering from polio crawls outside a row of closed shops in Siliguri, India in this December 8, 2006 file photo. REUTERS/Rupak De Chowdhuri/Files

VACCINE COMPLEXITIES

For the endgame in polio to succeed, a coordinated and complex vaccine switch is crucial.

Until now, many countries have been using a shot that protects against the three types of wild polio virus – type 1, type 2 and type 3 – but type 2 polio transmission has been stopped since 1999, meaning immunizing against it now makes no sense.

In rare cases it also poses a risk that the weakened type 2 virus in the vaccine can seep into circulation and cause “vaccine-derived” polio infections.

So from April 17 to May 1, some 150 countries will engage in a synchronized switch to a bivalent, or two-strain, vaccine that contains no type 2 virus but targets types 1 and 3.

It’s a massive undertaking and a major step towards eradication, says Zaffran. “We’re entering into uncharted territory. This has never been done before. But there’s no going back now.”

That’s partly because polio vaccine manufacturers – among them France’s Sanofi Pasteur – have moved production to the bivalent shot and would find it tricky, costly, and time-consuming to reverse that move.

Anil Dutta, a vaccine expert at British drugmaker GlaxoSmithKline, which also makes polio shots, is looking beyond eradication to 2019 or 2020, when all “live” oral polio vaccines need to be discontinued.

Then the world will switch again, to “inactivated” polio vaccine, or IPV, to further reduce any risk of causing disease through immunization. Scaling up IPV production to meet the needs of the entire world takes years, he warns, and work must start now to avoid potential supply concerns.

HISTORY OF MISSES

But prediction has never been easy in the fight to wipe out polio, and health authorities have missed targets along the way.

The Global Polio Eradication Initiative, launched in 1988, originally aimed to end all transmission of the disease by 2000.

And while there has been a 99 percent reduction in cases worldwide since the GPEI launch, fighting the last 1 percent of polio has been far tougher than expected.

In 2013, the GPEI said the global fight against polio would require $5.5 billion in funding, and more will be needed beyond that to keep a lid on the disease.

The virus, which invades the nervous system and can cause irreversible paralysis within hours, spreads rapidly among children, especially in unsanitary conditions in war-torn regions, refugee camps and areas where healthcare is limited.

In Pakistan and Afghanistan, the last two countries where polio currently remains endemic, conflict and propaganda have hampered progress, and in the past posed risks to others.

The campaign to eliminate polio in Pakistan is fraught with risk, with Islamist militants attacking health teams they accuse of being Western spies. A polio worker was shot and wounded in February and in January a suicide bomber killed 15 people outside a polio eradication center in the city of Quetta.

In 2011, a polio virus from Pakistan re-infected China, which had been polio free for more than a decade.

In 2013, the disease re-emerged in Syria after a 14-year absence, prompting the need for a vast and expensive regional emergency vaccination campaign.

And last year, cases of type 2 vaccine-derived polio posed new threats in Ukraine and Mali.

David Salisbury, an immunization specialist and associate fellow at Britain’s Chatham House Centre on Global Health Security, says the last 1 percent is a “very long tail” on a stubborn epidemic.

“The original date for interruption of transmission was 2000. The next target was 2014 and it’s currently 2016,” Salisbury told Reuters, adding that even with case numbers as low as they are now, “2016 may be optimistic”.

Liam Donaldson, head of the Independent Monitoring Board of the GPEI, agrees that celebrating the expected extinction of polio virus “would not just be premature, it would be folly”.

“Polio is still out there,” he told a meeting in London. “(It) has fought back with a vengeance at every stage of the game. And it’s still fighting.”

(Reporting by Kate Kelland; editing by Giles Elgood)

Next Story

Malaysia Launches Vaccination Campaign After 1st Polio Infection in 27 Years

The last case of polio registered in Malaysia occurred in 1992. Eight years later, the country was declared polio-free along with the other nations in the Western Pacific Region

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FILE - An Indian medical volunteer administers a dose of polio vaccine to a child in Hyderabad, India, Jan. 29, 2017. (Representational image). VOA

Malaysian health authorities on Monday launched a vaccination campaign in rural areas of the jungle-covered island of Borneo after detecting the first case of polio since the Southeast Asian country declared itself free of the viral disease in 2000.

The infected is a three-month-old boy in the town of Tuaran, who was hospitalized with fever and muscle weakness and tested positive for the virus on December 6, the Director-General of Malaysia’s Health Ministry, Noor Hisham Abdullah, said in a statement issued on Sunday.

“The patient is currently under treatment in an isolation ward and in a stable condition, but still requires respiratory support,” the official added in his statement.

Malaysia is the second Asian country to have recorded a polio infection this year after the Philippines, which declared an outbreak of the circulating vaccine-derived poliovirus (cVDPV) on September 19, reports Efe news.

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A child receiving vaccine drops. Wikimedia Commons

According to Noor Hisham, tests conducted by the World Health Organization’s Polio Regional Reference Laboratory in Melbourne showed that the virus detected in the Malaysian infant was genetically linked to the strain in the Philippines, which neighbours Borneo.

Noor Hisham said that a survey of polio-infected children in Sabah, one of Malaysia’s two states located on the north of Borneo, the world’s third-largest island, found that 23 out of 199 children aged between two months and 15 years had not been vaccinated.

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“This is a worrying situation, as the spread of polio can only be stopped with immunization,” he said. “Vaccination rates should always be higher than 95 per cent to prevent infection.”

The last case of polio registered in Malaysia occurred in 1992. Eight years later, the country was declared polio-free along with the other nations in the Western Pacific Region. (IANS)