Has the time come to celebrate end of polio?

Afghanistan and Pakistan, the world’s last bastion for endemic wild poliovirus, have recorded just two human cases in 2021



By Dr Ahmed Al Mandhari & Dr Faisal Sultan

Published: Sun 24 Oct 2021, 11:17 PM

Like every World Polio Day observed globally on October 24 for the last three decades, it’s a time for the Global Polio Eradication Initiative (GPEI) and its partners to celebrate progress made towards eradication and to rally support to tackle the challenges to come.

This year, though, a lot of us are just holding our breaths.

Holding our breaths because, despite 2021 being one of the most challenging years for public health in our lifetimes, Afghanistan and Pakistan, the world’s last bastion for endemic wild poliovirus, have recorded just two human cases.

Just two children paralysed by the vaccine-preventable disease that, 30 years ago, robbed the mobility of 350,000 children every year. It is the lowest case count in history.

Many people, and many reporters, are asking the same questions: Is this it? Are we close to eradicating?

But that’s not what’s keeping us up at night.

For polio eradicators, and especially those women and men dedicated to ousting the disease from its stronghold in this Region, it comes down to this: we have before us our last, best chance to eradicate.

It is a chance we have worked hard to earn, and it will not come again.

We all recall how this year dawned, in the grips of the Covid-19 pandemic’s brutal second wave. Across much of the Region, the polio programme was stretched thin, split between polio duties and responding to Covid-19.

Against this backdrop, we braced for a surge in cases following the four-month pandemic-necessitated pause in supplementary immunisation activity in both Afghanistan and Pakistan in 2020, and the lower-than-usual take up of routine immunization as families chose to stay home.

But quietly, we hoped. Although we had made real, meaningful progress in campaign quality in Pakistan, particularly in what we call super-high-risk Union Councils, we knew many children were still being persistently missed. And although we have rethought and redesigned our approach to vaccine-hesitant communities, many families were still avoiding vaccination.

Yet each of Afghanistan and Pakistan have reported just one child paralysed by wild poliovirus. Extensive environmental surveillance, the practice of testing sewage runoff for the presence of poliovirus, has shown a steady decline in the detection of wild poliovirus.

Diligent searching for acute flaccid paralysis, the primary symptom of polio infection, hasn’t yet yielded additional cases of wild poliovirus infection. But our surveillance tells us the virus is lurking, battling to survive, and waiting for the opportunity to attack more children.

As of Sunday, October 24, we know that 2021’s low case count isn’t a blip. It’s the result of hard work, aggressive innovation at programme and ground level, and the silver lining of Covid-19: fewer families on the move within and between Afghanistan and Pakistan, denying the virus a chance to skip from child to child as it once did.

We might have missed cases of polio, but we are doing all we can to find and eliminate poliovirus before it surprises us. To this end, a team of external international experts is concluding an extensive field review of our poliovirus detection systems, and we will implement their recommendations to increase the sensitivity of our surveillance system, especially in hard-to-reach populations. But what is clear is this: right now, today, we have the best chance we have ever had to achieve our great goal. And while we still have a lot to do, we know exactly how to do it.

We must continue to reduce the number of persistently missed children in core polio reservoirs, until immunity levels are robust enough that the virus has nowhere to go. We must partner with and engage vaccine-hesitant families.

The recently announced resumption of house-to-house polio vaccination campaigns across Afghanistan is timely and will give both Afghanistan and Pakistan’s programmes a huge boost. Sustained access to all children everywhere is the only way to eradicate.

We must maintain operational flexibility and coordination with security agencies to improve vaccination in areas where the security of our frontline workers is at risk. These are the areas where poliovirus has been recently detected and will most likely be the site of polio’s last stand.

We must ensure full national and provincial commitment to immediately mop up any circulating poliovirus detected, and we must support district teams in the rollout of this strategy.

And we must stand firm on our commitment to cross-border coordination and the vaccination of all children displaced from Afghanistan, no matter where they are.

We know the world is tired of polio. So are we. More than anyone, so are the children whose futures have been irrevocably diminished. But we are energised by the vision of a polio-free Pakistan and a post-polio world, and how that fits into our regional vision of health for all, by all.

In June, both of us took part in a global event to launch the GPEI’s new post-Covid 2022-2026 strategy, aptly titled “Delivering on a Promise”. That promise is eradication – the promise that every child on this planet can live without fear of paralysis from a vaccine-preventable disease.

Four months ago, our promise felt hopeful. Today, we feel the full weight of those words. The responsibility that comes with being so close, and knowing it is ours to lose.

As Special Assistant to the Pakistan Prime Minister on Health and as Regional Director, WHO EMRO, we re-affirm our promise. We are seizing this opportunity, and we will get the job done.

Dr Ahmed Al Mandhari is WHO Eastern Mediterranean Regional Director, and Dr Faisal Sultan is Special Assistant to the Pakistan Prime Minister on Health


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