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According to the Center for Disease Control and Prevention, polio, or poliomyelitis, is a crippling and potentially deadly infectious disease. The disease is very contagious and spreads from person to person. Children under the age of 5 are the main demographic affected by the virus. About 75% of individuals who do get infected with poliovirus will not have any visible symptoms. Approximately 25% of individuals will have flu-like symptoms. For a small, but unlucky group of people, the virus can invade the infected individual’s brain and spinal cord, causing paralysis.
Sounds scary, right? The good news is that if you live in the United States, you’ve probably been vaccinated against the disease with medicine that is more than 99% effective. Even better, the disease was officially eradicated from the United States in 1979.
Prior to the 1950s and the availability of the polio vaccine, polio was once considered one of the most feared diseases in the United States. As recently as 30 years ago, polio continued to paralyze more than 350,000 children each year in more than 125 countries. Worldwide, this number has dropped significantly due to increased vaccination rates and patient education. In 2018, there were only 28 documented cases of polio. The global drive to eliminate polio, which has gone on for 31 years and consumed over $16 billion, has endured recent set-backs by a surge of cases in Pakistan and Afghanistan. These are the only two countries left on the planet where polio remains endemic.
At the time of this report, there have been 94 cases reported so far this year in Afghanistan and Pakistan. The World Health Organization estimates that for every reported case, there are about 200 individuals who are infected but symptom-free and shedding the virus in their stool. The shedding will ultimately lead to the continued spread of the virus. Polio-prevention campaigns involving thousands of volunteers and a number of international agencies happen every year. Despite international efforts and the availability of a highly effective vaccine, dozens of children in these countries have become paralyzed and have ultimately died from the highly infectious disease this year. This begs the question: why does the virus continue to remain epidemic in this region of the world?
The answer has multiple layers to it. Most of the newly reported cases are comprised of a single large outbreak in the tribal regions of these countries along the border of the two countries as citizens flow freely back and forth. Unsecured borders, political unrest, poor health infrastructure, and government negligence in the region have contributed to the spread of the virus. These issues alone are certainly enough to cause a breakdown in eradication and vaccination efforts, but in addition to trying to cope with these factors, Afghanistan and Pakistan face another unique problem that is preventing total eradication: opposition from local religious and militant groups. Taliban factions have called vaccinations a Western plot to sterilize Muslim populations. In Pakistan’s North Waziristan tribal area, local Taliban leaders have also issued a ban on polio vaccinations until the United States ceases drone strikes in the area. Insurgents have claimed that some polio vaccinators are spies. False rumors that children are dying or fainting have led parents to turn away from vaccinators. Some Islamic clerics have even issued rulings saying that any person who became paralyzed or died from polio would be given the status of a “martyr” for refusing to be duped by a Western conspiracy. In a region that depends so heavily on rule and guidance from local religious leaders, these statements have been detrimental.
Despite the resistance from religious or militant groups, international organizations continue to push for eradication. In 2018, nearly 50 million Pakistani and Afghani children were vaccinated. The world currently sits on the cusp of an unprecedented public health success: the global eradication of human disease for only the second time in history.
A polio-free Afghanistan and Pakistan will mean a polio-free world.
In summary, vaccination is the single best way to prevent a polio infection and stop the spread of the disease. With the rise of the antivaccination movement in the United States, travelers and expatriates in Afghanistan and Pakistan should ensure that they are up to date on all vaccinations prior to travel. Documentation proving vaccination should be carried out while traveling. If you or your traveling companion wind up in a medical emergency situation in South Asia or anywhere else in the world, VIGILINT offers a comprehensive Global MedAssist Program (GMAP) including medical evacuation to your hospital of choice, access to our 24/7 Medical Operations Center, and our board-certified Emergency Medicine Physician team. Contact VIGILINT for more information: 1 (919) 914-0900.