Africa and Pakistan Face Polio Outbreaks, in Blow to Global Fight

Donald G. McNeil Jr., New York Times, August 23, 2013

The global effort to eradicate polio, a disease that has been on the brink of extinction for years, is facing serious setbacks on two continents. The virus is surging in Somalia and the Horn of Africa, which had been largely free of cases for several years. And a new outbreak has begun in a part of Pakistan that a warlord declared off limits to vaccinators 14 months ago.

The African outbreak began in May with just two cases of polio paralysis: one in Mogadishu, Somalia’s capital, and another in the huge Dadaab refugee camp in Kenya, where thousands of Somalis have fled fighting between Islamic militants, clan militias, government troops and African peacekeepers.

Now there are 121 cases in the region; last year, there were only 223 in the world.

The new Pakistan outbreak is in North Waziristan, near the frontier with Afghanistan. It is in an area where a warlord banned polio vaccinations after it was disclosed that the C.I.A. had staged a hepatitis vaccination campaign in its hunt for Osama bin Laden. The warlord, Hafiz Gul Bahadur, banned all efforts until American drone strikes ended.

Although only three North Waziristan children have suffered polio paralysis since then, even one case shows that the virus is in the area and could spread.

The new outbreaks may delay a recently announced $5.5 billion plan to eradicate polio by 2018. {snip}


The Pakistan outbreak is particularly frustrating because eradication had been going steadily forward despite the killings in December of nine vaccinators for which some blamed the Taliban.

Public health officials had counted themselves lucky that despite simultaneous vaccination bans in North and South Waziristan, no polio virus was known to be circulating in the 250,000 children in those areas. Vaccination posts were set up on nearby highways and on buses and trains. Urban hospitals packed the vaccine on ice for families willing to smuggle it back to neighbors. But it was not enough.

“The equation is simple,” said Dr. Elias Durry, emergency coordinator for polio eradication in Pakistan for the World Health Organization. “Where you can immunize, the virus goes away. Where you can’t, the virus gets in, and it will paralyze these poor kids.”


Before the Waziristan outbreak, Pakistan had seen only 24 cases this year, about as many as it had at the same point in 2012. Most were around Karachi and Peshawar, where last year’s killings of the vaccinators took place and where resistance to vaccines is highest.

The Somali outbreak is different. There is little opposition to the vaccine itself, said Dr. Bruce Aylward, the W.H.O. assistant director general for polio. In several Muslim countries, including Pakistan, the drive has been hurt by rumors that the vaccine sterilizes girls or contains the virus that causes AIDS or pork products.

But, he said, many cases are in areas south of Mogadishu where the Shabab, a militant group, operate. The group opposes mass campaigns because it believes the sight of thousands of vaccinators going house to house would undercut its claim to rule those areas.


Instead, the campaign negotiates with local chiefs and midlevel Shabab members to hold small drives.


Refugee camps face other obstacles. Large ones often have lawless areas on their fringes where vaccinators may fear to work because of predatory criminals.

“When this started, I said, ‘Brace yourself for hundreds of cases,’ ” Dr. Aylward said, because he knew that few children born in the last five years had been immunized.


Somalia is so dangerous for health workers that Doctors Without Borders pulled out of the country this month after 22 years there. But polio officials hope their campaign will not be targeted, largely because it creates thousands of temporary paying jobs for “volunteer” vaccinators.


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