Despite focused efforts to stop the transmission of wild poliovirus in 2017, to date this year 17 cases have been reported globally; six from Pakistan and 11 in Afghanistan. During a series of meetings to review progress in the two endemic countries, which make up one epidemiological block, members of the Technical Advisory Group (TAG) on polio eradication concurred that while both Pakistan and Afghanistan continue to make progress, continued transmission threatens gains already made towards interruption.
The TAG meetings, held in Islamabad and Kabul, recognized the efforts of both countries to coordinate activities closely, focusing on clearly identifying missed children, the reasons they have been missed, and putting in place operational plans to overcome these challenges. Efforts made to adjust national emergency action plans and build on the lessons learned from previous years and other countries have been commended by expert members of the TAG and hailed as key drivers behind the momentum.
TAG however reminded the country programmes of the remaining gaps and concluded that consistently reaching and vaccinating high-risk mobile population groups is essential if Afghanistan and Pakistan are to interrupt transmission over the coming months.
There were just 74 cases of polio reported worldwide in 2015. Thanks to a global vaccination drive, this crippling disease, which once affected hundreds of thousands of people a year, is now on the verge of extinction. The World Health Organisation estimates its eradication programme has saved around 5m people from a lifetime of paralysis.
But what happens when polio is finally gone? To make sure it does not come back, worldwide vaccination will have to continue. To keep producing a vaccine with current technology, we will have to retain enormous live stocks of the polio virus. This will run the risk of the virus escaping into the wild and restarting the disease – the opposite of what the vaccination programme is designed to do.
My colleagues and I are part of an international effort to come up with a new way of producing a polio vaccine that does not rely on us keeping the virus alive. The basic principle of a vaccine is to expose the body to a molecule known as an antigen that stimulates the immune system into fighting the related disease. This way, when the body encounters the actual disease, it has learnt how to react to it.
Vaccines have been in use in one form or another since the 10th century when ancient Chinese healers exposed healthy patients to powdered scabs from smallpox sufferers. Modern vaccine development relies on more controlled and safer forms of antigen exposure. In the case of virus-carried diseases like polio, the antigen is most often a weakened or deactivated version of the virus, made from a live strain.
It starts with a sick child, whose arms or legs have suddenly become weak and floppy. A trip to the local health centre, which could be many miles away, confirms that the child is showing classic signs of acute flaccid paralysis. This is one of the key indicators for poliovirus and kick starts the polio surveillance system into action. In Sudan, an innovative approach to transporting stool samples from potential polio cases to the laboratory for testing is making it even more likely that if polio returns, it will be found.
Strong surveillance to identify every case of acute flaccid paralysis is the golden standard of the polio eradication programme. In countries like Sudan, where the last case of wild poliovirus was seen in March 2009, it remains critical. Even though Sudan is now polio-free, it remains at risk of reimporting the virus, so a high level of vigilance is needed while polio continues to circulate anywhere in the world.
WHO has received reports of an attack on medical facilities in eastern Syrian Arab Republic that has destroyed the only vaccines cold room in al-Mayadeen district, Deir Ezzor Governorate.
More than 100,000 doses of measles vaccines and 35,000 doses of polio vaccines were stored in these facilities, alongside equipment, syringes, and stocks for all vaccine-preventable childhood diseases.
If confirmed, this would set back the efforts of WHO and health partners to protect the children of Deir Ezzor from preventable childhood diseases, including polio. WHO and local partners have intensified efforts to respond to an outbreak of polio that has affected 48 children in the Syrian Arab Republic since March this year.
“WHO has made strenuous efforts in cooperation with health authorities to deliver vaccines to protect the children living in these areas from disease,” said Elizabeth Hoff, WHO Representative in the Syrian Arab Republic. “We unequivocally condemn these actions. Vaccines are not a legitimate target of war.”
2017 is a year in which the fewest number of polio cases have ever been recorded. There is only 1 type of wild polio virus left, and reaching the last case is in our sights. This has not happened by chance or through luck but, rather, through a massive coordinated effort, which required huge political and resource commitment. I am not qualified to write about the epidemiological investigations, surveillance and monitoring advances in the field carried out through the Polio Eradication Initiative (PEI). Nor am I qualified to talk about the emergency centers set up in epidemic countries, the vaccine development and distribution breakthroughs - all of which are major contributors to the eradication effort.
What I would like to discuss is the role of communication and social change communication in the process and the need to retain the lessons and human resources that have been developed through this extensive effort.
My hope is that with these lessons we can go onto improving the health of millions of people worldwide, particularly in developing countries.
Plants are like a factory, powered by sunlight to manufacture food using carbon dioxide and water. Now, scientists have found a way to use a tobacco-like plant to create particles for a new polio vaccine.
In a study published in the journal Nature Communications in August, researchers from the John Innes Centre in the United Kingdom report that they successfully produced a polio vaccine using a tobacco-related plant called Nicotiana benthamiana. The plant manufactures virus-like protein particles that can be used to create vaccines.
The team chose the plant, which is native to Australia, because it grows quickly, has an effective plant immune system and is good at synthesizing proteins.
“It just happens to be a workhorse plant that’s been used for decades in plant research,” said Andrew Macadam, co-author of the study and principal scientist at the U.K.’s National Institute for Biological Standards and Control. “The plants are easy to work with.”
Interviews in the English language can only offer so much insight into polio eradication efforts in the trilingual nation of Sri Lanka.
“The administrators in Colombo are happy to discuss plans and progress in English, but workers in the districts discuss priorities, problems and achievements in Sinhalese and Tamil,” said Sanjoy Bhattacharya, professor of the history of medicine and director of the Center for Global Health Histories at the University of York.
Two decades of research and collaboration in public health campaigns across South Asia have taught him the importance of languages. Now, Bhattacharya is among those working to ensure that the documentation of the Global Polio Eradication Initiative, or GPEI, is multilingual. He is applying for funding from the Bill & Melinda Gates Foundation to build an international coalition that will advocate across multiple languages for future vaccination-based disease elimination and eradication programs.