Vox - The race to eradicate poliohttps://cdn.vox-cdn.com/community_logos/52517/voxv.png2014-05-19T17:20:08-04:00http://www.vox.com/rss/stream/54964412014-05-19T17:20:08-04:002014-05-19T17:20:08-04:00CIA says it's done with fake vaccination campaigns
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<img alt="A child with polio makes his way home using his crutches and special braces in 2009 in Kabul, Afghanistan." src="https://cdn.vox-cdn.com/thumbor/0hRL0Cb57gAQQggv78NIeFcH1UM=/142x0:2039x1423/1310x983/cdn.vox-cdn.com/uploads/chorus_image/image/33244667/91192656.0.jpg" />
<figcaption>A child with polio makes his way home using his crutches and special braces in 2009 in Kabul, Afghanistan. | Getty Images</figcaption>
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<p>The <a href="http://www.scientificamerican.com/article/how-cia-fake-vaccination-campaign-endangers-us-all/" style="background-color: #ffffff;">revelation</a> in 2011 that the CIA used a fake Hepatitis B vaccination program as part of its hunt for Osama bin Laden has often been cited as one reason that governments and parents are refusing vaccines in parts of Pakistan and Afghanistan.</p>
<p>Now the Obama administration has promised never to run a fake CIA vaccination campaign again.</p>
<p><q aria-hidden="true" class="right">the possible eradication of polio hinges largely on Pakistan</q></p>
<p><span>The director of the CIA has ordered the agency to "make no operational use of vaccination programs, which includes vaccination workers," a</span><span>ccording to a letter </span><a href="http://news.yahoo.com/after-bin-laden-backlash--cia-promises--no-more-fake-vaccination-campaigns-162615479.html;_ylt=AwrTWVXGRHpTBgMA5.3QtDMD" style="background-color: #ffffff; line-height: 1.5;">obtained</a><span> by Yahoo News.</span></p>
<p><span></span><span> The letter from the Obama administration was addressed to the deans of 12 public health schools in response to concerns about the use of public-heath programs in covert operations. (You can read the entire letter at Yahoo News.)</span></p>
<p>As I covered extensively in a <a href="http://www.vox.com/admin/entries/edit/5452153?community_id=441#wysiwyg">previous post</a>, the fate of polio hinges largely on Pakistan. And recent increase of polio cases in the region — caused, in part, by a lack of vaccinations — led the World Health Organization to declare polio a public health emergency earlier this month. The CIA rumors were one obstacle here — though far from the only one.</p>
<h3>Polio vaccination is currently stalled in parts of Pakistan</h3>
<p><q aria-hidden="true" class="right">Vaccine workers have been targets of violence</q></p>
<p>A lack of security can seriously complicate vaccination efforts in the Karachi metropolitan area, in Khyber Pakhtunkhwa (formerly known as the North-West Frontier Province), and in the semi-autonomous Federally Administered Tribal Areas (where many 2014 polio cases are occurring).</p>
<p>The Taliban has a strong presence in these areas, and v<span>accine workers have been targets of violence — dozens have been killed in targeted attacks.</span></p>
<p>There are some places where vaccinators can't go at all. In 2012, a Taliban commander <a style="background-color: #ffffff; line-height: 1.5;" href="http://www.nytimes.com/2012/06/19/world/asia/taliban-block-vaccinations-in-pakistan.html">banned</a> vaccinations against polio in North Waziristan until drone strikes ceased. Vaccination has also been essentially forbidden in South Waziristan and parts of Khyber Pakhtunkhwa. (Both North and South Waziristan are in FATA.)</p>
<p>Public-health officials <a href="http://www.vox.com/2014/5/7/5688112/why-polio-is-on-the-rise-again">have cited</a> the lack of vaccinations as one reason why polio cases are rising sharply in Pakistan.</p>
<h3>Yet most parents still want to vaccinate their children</h3>
<p>There are all sorts of rumors in Pakistan, public-health experts say, that vaccinations are some kind of Western plot to gather intelligence or sterilize children — or that they violate Islamic law.</p>
<p>Yet despite these rumors, most parents in Pakistan still want to vaccinate their children. For example, in the survey below, in August 2012, 67 percent of parents in FATA had heard negative rumors about the oral polio vaccine, but only 17.5 percent of those parents were chronically refusing to vaccinate their children:</p>
<p><img alt="Screen_shot_2014-05-19_at_2.55.29_pm" class="photo" src="http://cdn1.vox-cdn.com/assets/4476841/Screen_Shot_2014-05-19_at_2.55.29_PM.png"></p>
<p class="caption">Most parents who have heard bad rumors about OPV (oral polio vaccine) still vaccinate their children. UNICEF Polio Communications Quarterly Update May 2013</p>
<p class="caption"> </p>
<p>A more recent, unpublished poll finds that about 86 percent of parents in FATA think that vaccinating children for polio is a good or very good idea, according to a UNICEF source I talked to a few weeks ago. (UNICEF is in charge of the communication and vaccine-supply aspects of the polio eradication campaign.)<br><br>"People are really accepting of the concept of vaccination," Sherine Guirguis, UNICEF's senior communication manager for development for polio, told me. She's in charge of understanding communities' demands and perceptions about polio vaccinations.<b> </b><span>But, she says, "It can be tipped the other way if we don't keep our eye on it.</span></p>
<h3>Vaccine workers are using clever strategies to get vaccines to parents who want them</h3>
<p>Vaccine workers can't operate within some of these areas for political reasons, but they have been working around that to make vaccines available. For example, about 40 percent of families in North and South Waziristan also have homes in other districts.</p>
<p>So health workers have been offering vaccines at strategic transit points. They've been making sure that health care centers outside of these areas are fully stocked with polio vaccines. And there's also a huge effort to give vaccines to children crossing the Pakistan/Afghanistan border.</p>
https://www.vox.com/2014/5/19/5731834/the-cia-says-it-will-stop-doing-fake-vaccination-campaignsSusannah Locke2014-05-07T06:30:06-04:002014-05-07T06:30:06-04:00Why polio is back
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<img alt="An 11-year-old with polio plays soccer in Kabul, Afghanistan in 2009." src="https://cdn.vox-cdn.com/thumbor/ajnLSTqMomXP7LNIm_N6zYccROs=/0x0:2039x1529/1310x983/cdn.vox-cdn.com/uploads/chorus_image/image/32643551/91192894.0.jpg" />
<figcaption>An 11-year-old with polio plays soccer in Kabul, Afghanistan in 2009. | Getty Images</figcaption>
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<p>Public-health workers had nearly eradicated polio in the 20th century. So why is it making a comeback now?</p>
<p><q class="right" aria-hidden="true">Polio causes paralysis in about 1 in 200 cases</q></p>
<p>This week, the World Health Organization <a href="http://www.who.int/mediacentre/news/statements/2014/polio-20140505/en/">declared</a> a Public Health Emergency of International Concern — the second ever since the classification was created in 2005. The reason? Polio is spreading between countries — and during a time of year when cases are usually low. Already in 2014, there have been 74 confirmed cases of wild poliovirus, which causes paralysis in about 1 in 200 infections.</p>
<p>The news underscores a grim reality about polio. The World Health Organization has the money and the vaccines it needs to stamp out the disease out once and for all — but it hasn't been able to finish the job. A major obstacle is Pakistan, where heavy opposition to vaccination programs in some regions has let polio regain a foothold.</p>
<p>And there's a catch — the longer Pakistan takes to eradicate the virus, the more likely it is that other countries will let their guard down. If that happens, a major outbreak is entirely conceivable.</p>
<h3><span>We thought we had polio under control</span></h3>
<p>The fight against polio has been one of the big public health success stories of humankind — with the number of reported wild cases dropping from 350,000 in 1988 to 406 confirmed cases in 2013. This was achieved through a multi-billion-dollar international effort that has vaccinated billions of children.</p>
<p style="font-family: 'Alright Sans', sans-serif; font-size: 15px; line-height: 22.5px;"><img alt="Polio" class="photo" src="http://cdn1.vox-cdn.com/assets/4415975/Polio.jpg"></p>
<p>Indeed, the World Health Organization was so encouraged by the progress that they'd pledged to eliminate polio altogether by 2018. But those plans have now hit a snag.</p>
<h3>Now polio is making a comeback</h3>
<p>Over the past year, progress seems to have stalled. By the end of April in 2013, there were <a href="http://www.polioeradication.org/Dataandmonitoring/Poliothisweek.aspx">24 confirmed cases</a> of wild polio. By the same time in 2014, there were already 68:</p>
<p><img src="http://cdn3.vox-cdn.com/assets/4417893/Screen_Shot_2014-05-06_at_10.51.09_PM.jpg" class="photo" alt="Screen_shot_2014-05-06_at_10.51.09_pm"><span>68 cases may not seem like a big number — but it's a big deal. That's because very few people with the infection actually show symptoms (and because not every case of paralysis from polio gets officially diagnosed and confirmed). So behind every confirmed case are hundreds of other people carrying the virus and spreading it.</span></p>
<p><q class="right" aria-hidden="true">A big outbreak during the winter is bad news when the summer hits</q></p>
<p>Although some variation from year to year is normal, experts are particularly concerned because of transmission between countries. This year, i<span>t's happening during the cold months, when polio tends to spread slowly. The disease then propagates more rapidly in warmer months when there's more rain and contamination of water through sewage.</span></p>
<p>"If we have this much transmission in low season, what's going to happen in high season is it's going to multiply exponentially," says <span>Christy Feig, the </span><span>director of communications at the World Health Organization.</span></p>
<p>The WHO's official recommendations include immunization checks for people leaving Syria, Cameroon, and Pakistan, which have spread a few cases to other countries. Nigeria, which has historically had a major problem, seems to be doing much better, with two cases through the end of April.</p>
<h3><span>The big problem is in Pakistan — where vaccination efforts have stalled</span></h3>
<p>There's one country that seems to be at the epicenter of the latest polio revival: Pakistan.</p>
<p><q aria-hidden="true" class="right">59 out of 74 known cases of polio are in Pakistan</q></p>
<p>59 out of 74 known cases of polio are in Pakistan, a<span>ccording to the most recent numbers, which the WHO revealed in a press conference on May 5</span><span>. (The next highest count is Afghanistan, with four. Those cases came across the border from Pakistan.)</span></p>
<p>Not only is polio increasing inside Pakistan's own borders, the country has also been exporting the disease. Polio strains that originated in Pakistan have spread cases to Afghanistan, Syria, and Iraq. (The latter two states had been polio-free for more than a decade.) They've also turned up in the sewers of Israel and Egypt, but without any confirmed cases of people getting ill.</p>
<p>So what's going on? One big cause is that vaccination in Pakistan has stalled.</p>
<p>"It’s primarily a security problem," says Steve Wassilak, a m<span>edical epidemiologist at the </span><span>Global Immunization Division of the US </span><span>Centers for Disease Control and Prevention. </span><span>"There’s a bit of disenfranchisement of the Pashtun community, but it’s relatively minor when compared to the issue of actual security in the area." </span></p>
<p><span></span><span>Security matters seriously complicate vaccination efforts in the Karachi metropolitan area</span><span>, </span><span>Khyber Pakhtunkhwa (</span>formerly known as the North-West Frontier Province<span>), and </span><span>the semi-autonomous Federally Administered Tribal Areas (where many 2014 polio cases are occurring)</span><span>. T</span>he Taliban has a strong presence in each area.</p>
<p><span>V</span><span>accine workers have been targets of violence — dozens have been killed in targeted attacks.</span></p>
<p><span>And vaccinators can't even try to operate in some places altogether. </span><span>I</span><span>n 2012, a Taliban commander </span><a style="background-color: #ffffff; line-height: 1.5;" href="http://www.nytimes.com/2012/06/19/world/asia/taliban-block-vaccinations-in-pakistan.html">banned</a><span> </span><span>vaccinations against polio in North Waziristan until drone strikes stop. Vaccination has also been essentially forbidden in South </span><span>Waziristan and parts of </span><span>Khyber Pakhtunkhwa</span><span>. (Both North and South Waziristan are in FATA.)</span></p>
<p><span>This general area tends to be more wary of polio vaccination programs, including rumors that the vaccine </span><span>violates Islamic law or is</span><span> a Western plot that causes sterilization. </span>The <a href="http://www.scientificamerican.com/article/how-cia-fake-vaccination-campaign-endangers-us-all/">revelation</a> in 2011 that the CIA used a fake Hepatitis B vaccination program as part of its hunt for Osama bin Laden certainly wasn't of any benefit to the polio program, either. "It isn't the cause of where we're at with polio right now, but it certainly hasn't helped and has made the situation in Pakistan weaker," says Heidi Larson, an anthropologist who studies public trust and vaccines at the London School of Hygiene & Tropical Medicine and is the former Global Communication for Immunization at UNICEF<font style="line-height: 1.5;" face="ProximaNovaRg, Helvetica, Arial, sans-serif" color="#444444">.</font></p>
<p>Whatever the causes, public-health experts say the situation in Pakistan has reached a critical stage. "If Pakistan doesn’t step up the game and do their part, we are going to lose control of the effort to control polio," WHO director of communications Christy Feig told me. "In some areas they have stopped vaccination campaigns, and they need to start increasing those vaccination campaigns in order to get the virus under control."</p>
<h3>How polio could make a comeback worldwide</h3>
<p>A few dozen cases in Pakistan may not seem like the biggest deal. But, in many ways, this is a race against time. The longer it takes for Pakistan to eradicate polio, the more likely it is that the disease could spread around the world.</p>
<p><q aria-hidden="true" class="right">In many ways, this is a race against time</q></p>
<p>Here's why. Many countries have already eradicated polio. But, over time, people in those countries are likely to get lackadaisical and stop vaccinating, thinking that polio is no longer a threat. Those unvaccinated populations — including millions of children in Europe — would then be extremely susceptible to the virus if it ever entered their borders.</p>
<p>The World Health Organization says that it's still on target to finish off polio for good in 2018. But that depends largely on vaccination programs in Pakistan. And if those continue to stall, the risks of a worldwide outbreak could grow.</p>
<p><b>Update: </b>Added a statement from the CDC and additional details about security issues and vaccination bans in Pakistan.</p>
https://www.vox.com/2014/5/7/5688112/why-polio-is-on-the-rise-againSusannah Locke