United Nations health agencies already struggling with a surging COVID-19 pandemic must now face the possibility the United States will abdicate its leading role fighting polio—just as the world gets tantalizingly close to eradicating it for good.
The U.S., polio-free since 1979, has historically made combating the infectious disease its top funding priority at the World Health Organization, investing more than $158 million in voluntary contributions over the last two years alone. The effort has broad public support dating to the 1950s, when Jonas Salk, with the help of the March of Dimes charity, created the first polio vaccine.
Older Americans still have “horrific” memories of polio sufferers in iron lungs, notes Dr. Hamid Jafari, director of the WHO’s polio eradication program in the eastern Mediterranean region, and the U.S. has an “emotional investment” in polio eradication.
After Nigeria was declared free of wild poliovirus in 2016, Pakistan and Afghanistan became the globe’s only countries with recorded wild polio cases, with 12 and 49 cases, respectively. (Wild polio is different from the rare, more easily controlled “circulating vaccine-derived poliovirus,” of which there are 134 known cases worldwide. Communitywide vaccinations prevent the spread of both types of polio.)
But despite the success of polio vaccination efforts, the WHO is warning that failure to eradicate it from these last remaining areas could produce a resurgence worldwide, with as many as 200,000 new cases annually over 10 years. A mutated strain of poliovirus has been reported in more than 30 countries, and the impact of the COVID-19 pandemic slowing or stopping vaccination campaigns has been particularly dire for polio eradication—around 85,000 Congolese children have not received that vaccine.
President Trump’s withdrawal from the WHO on May 29 now threatens these polio-control efforts already complicated by the COVID-19 pandemic.
“Polio vaccination campaigns have been put on hold,” WHO Director-General, Tedros Adhanom Ghebreyesus, said at a media briefing during World Immunization Week in April. Poor countries are reporting shortages of vaccines due to border closures to contain the spread of COVID-19—and children, while at relatively low risk for severe illness and death from the novel coronavirus, remain at high risk for life-threatening infectious diseases like measles and polio, Ghebreyesus said.
Efforts to control polio overlap with other public health campaigns, including the containment of COVID-19. As of June 15, Afghanistan had 25,527 confirmed cases of COVID-19 and 476 deaths, though numbers are certainly much higher given the country’s limited health services. (The country’s population is approximately 35 million.)
U.S. Secretary of State Michael Pompeo recommended in April that funding for seven countries continue despite Trump’s actions against the WHO: Afghanistan, Egypt, Libya, Pakistan, Sudan, Syria and Turkey. Pompeo argued that the UN agency is critical in those countries to fight COVID-19 and polio.
A March 27 State Department fact sheet, titled “The United States Is Leading the Humanitarian and Health Assistance Response to COVID-19,” says the U.S. has redirected $10 million in resources to support the UN’s emergency response to COVID-19 through the WHO. “This support will include surveillance, lab improvements, case management, infection prevention and control, community engagement, and technical assistance to Government of Afghanistan.”
The State Department, however, did not provide comment to PassBlue’s requests on the status of Pompeo’s recommendation or on the commitment of the U.S. to ending polio.
Meanwhile, volunteers with the polio program in Afghanistan encourage hand-washing; staff members in the field check for and report potential cases of COVID-19; and program staffers strive to improve health workers’ ability to respond to the coronavirus.
UNICEF is using its Immunization Communication Network to disseminate information on personal hygiene, and the WHO’s Afghanistan polio team is coordinating with the government to combat COVID-19.
Speaking from Amman, Jordan, Dr. Jafari of the WHO told PassBlue that the agency remains committed to “polio observation” even as vaccination efforts are curtailed to protect both Afghan populations and international health care workers from the spread of COVID-19. Dr. Jafari noted that the pandemic has increased the agency’s mandate, and this will increase its budget needs. “We can’t go back just with polio vaccine in these communities that have been devastated by COVID-19.”
Dr. Jafari expressed concern for the populations that are “most vulnerable” to both COVID and polio, including refugees and displaced people from places like Somalia, Afghanistan, Syria and Yemen, where the UN is trying to maintain polio observation. He also said that UN staff are “running toward danger” as they do their jobs. “There is a human component to what we are discussing,” he said. “We need to recognize the morale issues.”
Dr. Jafari declined to speculate about how the U.S. withdrawal of money would affect the agency’s polio work. Calling the U.S. “an important partner for WHO and the overall health sector in Afghanistan,” he said the agency is “fortunate to have many other international and national health sector partners in Afghanistan.”
(Earlier this month, numerous world leaders, led by Boris Johnson of Britain, pledged an additional $8.8 billion for Gavi, the Vaccine Alliance, to help immunize 300 million more children in the world’s poorest countries against polio, measles and diphtheria by the end of 2025.)
Work on wiping out polio is primarily funded through the Global Polio Eradication Initiative, a public-private partnership whose core partners include the WHO, Rotary International, the U.S. Centers for Disease Control and Prevention (CDC), UNICEF, the Bill & Melinda Gates Foundation and Gavi. “We’ve come too far to let this program fail,” Dr. Jafari said.
Jafari, a former principal deputy director at the CDC’s Center for Global Health in Atlanta, said the Global Polio Eradication Initiative relies on the CDC primarily for lab virology and on the WHO for strategy, monitoring and evaluation.
PassBlue spoke with Mohammed Mohammedi, a polio vaccine expert, during his recent trip to Lashkar Gar, in Afghanistan’s Taliban-heavy Helmand Province. Based in Kabul, he is UNICEF’s section chief for polio eradication and traveled to the unstable region to help prevent the spread of both COVID-19 and polio through education and distribution of basics like soap.
It would be “a great shame,” Mohammedi , if with billions of dollars invested and great success achieved, the fight against polio was lost because the job could not be finished in just two countries: Afghanistan and Pakistan.
“Polio is the easiest disease to get rid of,” Mohammedi said in a WhatsApp chat. “Anybody can give a vaccine to any child. It’s drops in the mouth. It doesn’t require any qualifications. The vaccine is very stable and it’s very cheap.”
Arguing that decreased funding could “force the programs at country level to really assess who is needed and who is not,” Mohammedi said political commitment was more important than money.
“If we get serious, we can eradicate polio from Afghanistan in one year,” he said. “There are only two people who can decide this. One is Gates and the other is Trump. And Trump will never do it.”
The Gates Foundation has made eradicating polio a top priority. But Bill Gates himself has said that polio is not likely to be eradicated without the WHO.
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